Most Relevant Information
Provider Data
| NPI Number: | 1003317702 |
| Provider Name: | THERESE TICZON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/27/2018 |
| Last Updated: | 02/27/2018 |
Provider Practice Location
1335 N DUTTON AVE
SANTA ROSA
CA
954014609
Practice Location Phone/Fax
| Phone: | 8552237123 |
| Fax: |
Provider Mailing Location
16782 VON KARMAN AVE STE 11
IRVINE
CA
926062417
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |