Individual
KEIVENCIA PELIA ANNE MYRTEL DOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12826 SE 40TH LN STE A10, BELLEVUE, WA 98006-5266
(832) 949-9626
Mailing address
711 21ST AVE APT 3, SEATTLE, WA 98122-4737
(832) 949-9626
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
61458410
WA
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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