Individual
WYATT FETROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20010 MANDERSON ST STE 104, ELKHORN, NE 68022-1264
(972) 777-1331
Mailing address
20010 MANDERSON ST STE 104, ELKHORN, NE 68022-1264
(972) 777-1331
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/09/2026
Last updated
01/09/2026
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