Most Relevant Information
Provider Data
| NPI Number: | 1003319633 |
| Provider Name: | MARISSA WALTEN RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 17-45543 |
Most Important Dates
| Enumeration Date: | 03/09/2018 |
| Last Updated: | 07/06/2020 |
Provider Practice Location
5250 CLAREMONT AVE # 135
STOCKTON
CA
952075700
Practice Location Phone/Fax
| Phone: | 8182416780 |
| Fax: |
Provider Mailing Location
1055 E COLORADO BLVD STE 560
PASADENA
CA
911062380
Provider Mailing Phone/Fax
| Phone: | 8182416780 |
| Fax: | 8182416853 |