Individual
AN LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1502 SE 28TH ST, BENTONVILLE, AR 72712-3988
(479) 521-8326
Mailing address
216 OLD FARMINGTON RD, FARMINGTON, AR 72730-4008
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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