Genevieve Autumn-Rose Judith Lyeth
NPI #1124602354 in Edwardsville, Illinois
Provider Information
- NPI Number
- 1124602354
- Entity Type
- Individual
- Name
- Genevieve Autumn-Rose Judith Lyeth
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Behavior Technician
- Enumeration Date
- May 12, 2021
- Last Updated
- May 12, 2021
Practice Location
- Address
- 400 SAINT LOUIS ST STE 1
- City
- Edwardsville
- State
- Illinois
- ZIP Code
- 62025-1979
- Phone
- (844) 244-1818
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Technician |
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