Individual
ALYCEA LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1087 E PARK BLVD, SUITE 100, BOSIE, ID 83712
(208) 369-9168
Mailing address
1331 S BIRD ST APT 103, BOISE, ID 83709-1489
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-306234
ID
Other
Enumeration date
12/26/2024
Last updated
12/26/2024
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