Cody Thammavongsa
Behavior Technician in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1154064483
StatusActive
Last updated in NPPESApr 14, 2022
Details
- NPI
- 1154064483
- Entity type
- Individual (NPI-1)
- Name
- Cody Thammavongsa
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 14, 2022
- Certification date
- Apr 14, 2022
- Last updated
- Apr 14, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
120 Stevens St SwGrand Rapids, MI 49507-1526
Phone 855-832-6727
Mailing address
7108 S Kanner HwyStuart, FL 34997-7462
Phone 855-832-6727 · Fax 772-675-9100
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