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1518453919
TREVOR IRA PRUETT
LA CROSSE, WI
NPI
1518453919
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2018-07-09
Last Update Date
2018-07-09
Business Address
TREVOR IRA PRUETT
901 CALEDONIA ST
LA CROSSE, WI 54603-2616
Phone number: 608-785-4100
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Mailing Address
TREVOR IRA PRUETT
14301 EWING AVENUE
BURNSVILLE, MN 55306
Phone number: 952-746-5350
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