Raelin C Derevencha

NPI #1609479963 in Nixa, Missouri

Provider Information

NPI Number: 1609479963
Entity Type: Individual
Name: Raelin C Derevencha
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Nov 19, 2020
Last Updated: Jul 26, 2021

Practice Location

Address: 116 W SHERMAN WAY STE 1
City: Nixa
State: Missouri
ZIP Code: 65714-9022
Phone: (417) 298-0984

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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