Individual
AUTUMN ROSE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2549 NORTH STOKESBERRY PLACE, MERIDIAN, ID 83646
(208) 918-4665
Mailing address
9201 OAKDALE AVE STE 101, CHATSWORTH, CA 91311-6546
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
12685
ID
Other
Enumeration date
05/05/2022
Last updated
05/05/2022
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