Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003201898 |
---|---|
Provider Name | Adam Wenzel |
First Address | Duluth, MN 55806-1524 |
Second Address | Duluth, MN 55802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 22/10/2018 |