Individual
ETHAN WESLEY YAZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6330 NW KELLY DR STE A, PARKVILLE, MO 64152-4027
(816) 469-5162
Mailing address
503 NE TUDOR RD, LEES SUMMIT, MO 64086-5613
(314) 920-1403
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/01/2020
Last updated
06/01/2020
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