Dina Breanne Maxine Woodworth Valid NPI
Individual provider · Behavior Analyst · O Fallon, IL
- NPI
- 1053955906
- Type
- Individual (Type 1)
- Primary specialty
- Behavior Analyst
- Specialty group
- Behavioral Health & Social Service Providers
- Taxonomy code
- 103K00000X
- License number
- W363-1629-3972 (IL)
- Sex
- Female
- Sole proprietor
- No
- Enumerated
- 2019-11-04
- Last updated
- 2019-11-04
Practice location
634 N Main St
O Fallon, IL 62269-3751
(618) 726-0701