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1780121731
GORDON JOHN WALLER
OREM, UT
NPI
1780121731
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
Additional Taxonomies
101YM0800X Counselor Mental Health
Enumeration Date
2017-01-30
Last Update Date
2021-01-12
Business Address
GORDON JOHN WALLER
475 W 260 N
OREM, UT 84057-1970
Phone number: 801-221-9930
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Mailing Address
GORDON JOHN WALLER
475 W 260 N
OREM, UT 84057-1970
Phone number:
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