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General NPI Number Information
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NPI Number | 1386361889
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Entity Type | Individual
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Provider Name | ADALYN SNOW GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 8777 SAN JOSE BLVD STE 801
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4291
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Country | US
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Telephone | 904-374-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 LEON RD APT 2321
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8674
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Country | US
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Telephone | 727-290-5120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB787486
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License Number State | FL
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