Kelly Jannea Mantz
Behavior Technician in Vancouver, WA. Individual provider (NPI-1).
NPI number1245926682
StatusActive
Last updated in NPPESMay 9, 2024
Details
- NPI
- 1245926682
- Entity type
- Individual (NPI-1)
- Name
- Kelly Jannea Mantz
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 17, 2023
- Certification date
- May 9, 2024
- Last updated
- May 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | CB61450960 | WA | Yes |
Practice location
6409 E Mill Plain BlvdVancouver, WA 98661-7454
Phone 360-718-8376
Mailing address
6409 E Mill Plain BlvdVancouver, WA 98661-7454
Phone 360-718-8376
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