Individual
NICOLE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1085 MAPLE ST, FARMINGTON, MO 63640-1955
(573) 756-5353
(573) 756-4557
Mailing address
1085 MAPLE ST, FARMINGTON, MO 63640-1955
(573) 756-5353
(573) 756-4557
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/10/2011
Last updated
08/10/2011
About Stedi
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