Individual
MALLORY NICOLE FLETCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16538 N MAY AVE, EDMOND, OK 73012-9007
(405) 265-9208
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-51048
OK
106S00000X
Behavior Technician
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200905720A
—
OK
Enumeration date
05/08/2020
Last updated
09/06/2022
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