Individual
MARCUS JERMAINE BROADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3555 SUNSET OFFICE DR STE 101, SAINT LOUIS, MO 63127-1045
(314) 377-5968
Mailing address
8300 JEFFERSON ST NE STE B, ALBUQUERQUE, NM 87113-1734
(505) 447-3825
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24333190
MO
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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