Individual
AUTUMN BOOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6720 TOMAHAWK TRL, GRAYLING, MI 49738
(989) 915-0764
Mailing address
6720 TOMAHAWK TRL, GRAYLING, MI 49738-8921
(989) 915-0764
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34991694
—
MI
Enumeration date
12/28/2016
Last updated
12/28/2016
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