Roosevelt Dismukes JR.

NPI #1225525744 in Hayti, Missouri

Provider Information

NPI Number: 1225525744
Entity Type: Individual
Name: Roosevelt Dismukes JR.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Apr 19, 2018
Last Updated: Apr 19, 2018

Practice Location

Address: 500 HIGHWAY 61 N J
City: Hayti
State: Missouri
ZIP Code: 63851
Phone: (573) 359-2600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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