Individual
KELLY LAMAR MIGNONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
373 S WILLOW ST STE 266, MANCHESTER, NH 03103-5751
(877) 315-8080
(877) 345-4009
Mailing address
702 LOCUST DR, CLARKSVILLE, TN 37040-4247
(615) 509-5565
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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