Individual
ANGELA STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
300 W SWANSON AVE, WASILLA, AK 99654-6844
(907) 521-0890
Mailing address
300 W SWANSON AVE, WASILLA, AK 99654-6844
(907) 521-0890
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT19108430
AK
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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