Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003304890 |
---|---|
Provider Name | William Edward Wendt |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Killeen, TX 76541-9147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 26/04/2018 |