Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013242635 |
---|---|
Provider Name | Jennifer N Wilson |
First Address | Panama City, FL 32405-5412 |
Second Address | Panama City, FL 32405-5412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2009 |
Last Update Date | 15/10/2009 |