Individual
MRS. KATHERINE MARIE LASK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
612 WYMA PL, EDWARDSVILLE, IL 62025-2459
(630) 640-1636
Mailing address
612 WYMA PL, EDWARDSVILLE, IL 62025-2459
(630) 640-1636
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/25/2015
Last updated
11/25/2015
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