Individual
JORDAN MICHAEL PETZOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1417 N MOUNT AUBURN RD STE C, CAPE GIRARDEAU, MO 63701-2171
(573) 271-5240
Mailing address
206 OAKLANE DR, CAPE GIRARDEAU, MO 63701-9549
(573) 270-9556
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/03/2021
Last updated
03/03/2021
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