Individual
KIMBERLY DERQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1421 TRIAD CENTER DR, SAINT PETERS, MO 63376-7357
(636) 248-7841
Mailing address
4848 DALTREY CT, SAINT LOUIS, MO 63129-1655
(636) 524-2136
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
894991
MO
Other
Enumeration date
06/10/2025
Last updated
06/10/2025
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