Individual
KENDAL BROOKE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10109 LAKE CREEK PKWY # 170776, AUSTIN, TX 78729-1711
(971) 666-5675
Mailing address
PO BOX 170776, AUSTIN, TX 78717-0034
(971) 666-5675
(833) 485-5167
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-65346
TX
106S00000X
Behavior Technician
—
—
Other
Enumeration date
07/12/2022
Last updated
04/25/2023
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