Individual
DOMINIQUE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 AMERICAN BLVD E STE 10, BLOOMINGTON, MN 55425-1217
(901) 601-8342
Mailing address
1801 AMERICAN BLVD E STE 8, BLOOMINGTON, MN 55425-1230
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/14/2021
Last updated
06/22/2021
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