Individual
KAELYNNE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8811 S TACOMA WAY STE 204&206, TACOMA, WA 98499-4595
(253) 559-0323
Mailing address
5107 351ST ST E, EATONVILLE, WA 98328-9717
(253) 886-3039
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/03/2022
Last updated
02/03/2022
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