Individual
JESSICA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2222 S 114TH ST, WEST ALLIS, WI 53227-1031
(414) 449-4444
Mailing address
2222 S 114TH ST, WEST ALLIS, WI 53227-1031
(414) 449-4444
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269-140
WI STATE LICENCE - BEHAVIOR ANALYST
WI
Enumeration date
04/19/2017
Last updated
12/11/2018
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