Individual
ANTONESHA BASS-GAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAS DEGREE
Contact information
Practice address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
(763) 231-2590
Mailing address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
(763) 231-2590
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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