Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-143190 |
NPI | 1003418716 |
---|---|
Provider Name | Isabella Lilliepauline Wilson |
First Address | Gardnerville, NV 89410-5140 |
Second Address | Reno, NV 89521-6101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 09/11/2020 |