Individual
MARY DURANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
371 E 1ST ST, FOND DU LAC, WI 54935-4563
(920) 907-3928
Mailing address
371 E 1ST ST, FOND DU LAC, WI 54935-4563
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-20-129777
WI
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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