Individual
KODY DEAN WALLEEN-SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
7261 W CHARLESTON BLVD, LAS VEGAS, NV 89117-1636
(702) 742-4248
Mailing address
7261 W CHARLESTON BLVD, LAS VEGAS, NV 89117-1636
(702) 742-4248
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
177029
NV
Other
Enumeration date
10/01/2016
Last updated
10/01/2016
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