Individual
BAILEY WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
6131 N CLINTON ST, FORT WAYNE, IN 46825-4905
(260) 459-6040
Mailing address
5601 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 459-6040
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-278323
IN
Other
Enumeration date
05/06/2025
Last updated
05/06/2025
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