Individual
MARY LAUDERDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
212 S LINCOLN ST, LOWELL, AR 72745-9782
(479) 770-0744
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-203007
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273474706
—
AR
Enumeration date
03/07/2022
Last updated
01/09/2023
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