Individual
SHELBY KIMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 BROOKHILL SQ S, SUGARLOAF, PA 18249-1016
(570) 578-5687
Mailing address
830 WALNUT ST, FREELAND, PA 18224-1324
(570) 578-5687
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5708023099
MISSION AUTISM CLINICS
PA
Enumeration date
04/23/2021
Last updated
04/23/2021
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