Individual
AMANDA WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
514 WINGATE DR, CLARKSVILLE, TN 37043-6011
(615) 481-4899
Mailing address
514 WINGATE DR, CLARKSVILLE, TN 37043-6011
(615) 481-4899
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB727739
TN
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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