Individual
SHAYNE WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2048 E MADISON AVE, BASTROP, LA 71220-4035
(318) 379-3214
Mailing address
2703 STERLINGTON RD APT 49, MONROE, LA 71203-2565
(716) 427-8411
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-903
LA
Other
Enumeration date
11/08/2024
Last updated
11/08/2024
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