Individual
MISS MACY JAYNE WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NONE
Contact information
Practice address
7777 BONHOMME AVE STE 1800, CLAYTON, MO 63105-1931
(636) 202-0693
(249) 485-5568
Mailing address
7777 BONHOMME AVE STE 1800, CLAYTON, MO 63105-1931
(636) 202-0693
(249) 485-5568
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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