Individual
ANGELICA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
39201 STATE ST, FREMONT, CA 94538-1437
(866) 206-2008
(866) 317-1665
Mailing address
1957 KNOLLS DR, SANTA ROSA, CA 95405-8367
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/22/2018
Last updated
02/25/2021
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