Individual
DANIELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 E WASHINGTON ST STE 130, MEDINA, OH 44256-3331
(234) 255-8531
Mailing address
805 E WASHINGTON ST STE 130, MEDINA, OH 44256-3331
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-161086
OH
Other
Enumeration date
04/06/2021
Last updated
04/06/2021
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