Individual
ANNA KIRSANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4031 N KENMORE AVE APT 204, CHICAGO, IL 60613-5430
(339) 221-1775
Mailing address
4031 N KENMORE AVE APT 204, CHICAGO, IL 60613-5430
(339) 221-1775
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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