Individual
DANESSA TYKIETA CLAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-6502
Mailing address
205 PORTLAND ST, COLUMBIA, MO 65201-6521
(573) 884-4660
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-97397
MO
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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