Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003372681 |
---|---|
Provider Name | Kristy Hazel Wilder |
First Address | Salt Lake City, UT 84124-1455 |
Second Address | Salt Lake City, UT 84124-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |