Individual
GRACE MACKENZIE TEMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
606 W 1720 N APT 206, PROVO, UT 84604-2476
(847) 826-3883
Mailing address
606 W 1720 N APT 206, PROVO, UT 84604-2476
(847) 826-3883
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
40938791
TX
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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