Individual
EMILY ELIZABETH SHADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1048 ASHLEY ST STE 101, BOWLING GREEN, KY 42103-2449
(270) 843-5300
Mailing address
PO BOX 931142, ATLANTA, GA 31193-1142
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-311590
KY
Other
Enumeration date
02/08/2024
Last updated
02/08/2024
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