Individual
ELIZABETH GRACE WOMBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3155 N COLLEGE AVE STE 108, FAYETTEVILLE, AR 72703-3500
(479) 957-9121
Mailing address
1388 S LAGUNA LOOP APT 1006, FAYETTEVILLE, AR 72701-4321
(913) 952-6242
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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