Individual
JENNIFER DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA, BSL
Contact information
Practice address
1122 WYOMING AVE, EXETER, PA 18643-1918
(570) 655-1667
Mailing address
207 E 8TH ST, WYOMING, PA 18644-2040
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH001760
PA
Other
Enumeration date
01/30/2018
Last updated
01/30/2018
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