Individual
BRIAN T STAUB I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W SWANSON AVE, WASILLA, AK 99654-6844
(907) 521-0890
Mailing address
PO BOX 521196, BIG LAKE, AK 99652-1196
(907) 854-0668
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-75924
AK
Other
Enumeration date
01/14/2019
Last updated
01/14/2019
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