Individual
HAVEN SIDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1628 E DOROTHY LN, KETTERING, OH 45429-3810
(937) 365-7455
(937) 600-6071
Mailing address
1628 E DOROTHY LN, KETTERING, OH 45429-3810
(937) 365-7455
(937) 600-6071
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-236356
OH
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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