Individual
MARIA KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 MAIN AVE, FARGO, ND 58103-6811
(701) 365-8868
Mailing address
4412 17TH ST S, MOORHEAD, MN 56560-7143
(701) 320-1514
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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