Individual
MS. MADLYN REGINA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 W CHEYENNE AVE STE 30, NORTH LAS VEGAS, NV 89030-7817
(702) 487-5665
Mailing address
720 W CHEYENNE AVE STE 30, NORTH LAS VEGAS, NV 89030-7817
(702) 487-5665
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1401577626
—
NV
Enumeration date
10/12/2011
Last updated
10/12/2011
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