Individual
AMBER S WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Mailing address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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