Dominique Alysia Davis
Behavior Technician in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1669288288
StatusActive
Last updated in NPPESDec 9, 2024
Details
- NPI
- 1669288288
- Entity type
- Individual (NPI-1)
- Name
- Dominique Alysia Davis
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 9, 2024
- Certification date
- Dec 9, 2024
- Last updated
- Dec 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
601 Noble DrFort Wayne, IN 46825-5544
Phone 260-420-9332
Mailing address
601 Noble DrFort Wayne, IN 46825-5544
Phone 260-420-9332
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