Individual
ALIX WANLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
41521 W 11 MILE RD, NOVI, MI 48375-1803
(248) 299-0030
Mailing address
600 BROADWAY AVE NW APT 320, GRAND RAPIDS, MI 49504-7320
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/15/2017
Last updated
11/29/2022
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