Individual
MRS. LEILA WADE SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 N WALTON BLVD, BENTONVILLE, AR 72712-4302
(479) 802-4798
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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