Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 8954 | AK |
NPI | 1003287673 |
---|---|
Provider Name | Danielle Wolak |
First Address | Wasilla, AK 99654 |
Second Address | Wasilla, AK 99654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2015 |
Last Update Date | 17/03/2018 |