Individual
MAYA BRIANNA BOLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16941 N EAGLE RIVER LOOP RD, EAGLE RIVER, AK 99577-7824
(907) 726-5330
Mailing address
24550 PARK DR, CHUGIAK, AK 99567-6225
(907) 406-7430
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-9999
APPLIED BEHAVIOR ANALYSIS
AK
Enumeration date
09/13/2018
Last updated
09/13/2018
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