Individual
FARIS ELAINE WINCHESTER RUSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1625 ADVENTURELAND DR, ALTOONA, IA 50009-2237
(515) 967-4369
Mailing address
1625 ADVENTURELAND DR, ALTOONA, IA 50009-2237
(515) 967-4369
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/24/2022
Last updated
01/24/2022
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