Individual
EVAN CLARK GALLOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 STEVENS ST SW, GRAND RAPIDS, MI 49507-1526
(855) 832-6727
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
(269) 578-3069
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60115569
—
MI
Enumeration date
04/14/2022
Last updated
04/14/2022
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