Most Relevant Information
Provider Data
| NPI Number: | 1003489279 |
| Provider Name: | ALYSSA SHAW |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/23/2021 |
| Last Updated: | 07/23/2021 |
Provider Practice Location
3155 N COLLEGE AVE STE 108
FAYETTEVILLE
AR
727033500
Practice Location Phone/Fax
| Phone: | 4799579121 |
| Fax: | 4797779967 |
Provider Mailing Location
3155 N COLLEGE AVE STE 108
FAYETTEVILLE
AR
727033500
Provider Mailing Phone/Fax
| Phone: | 4799579121 |
| Fax: | 4797779967 |