Individual
COLEEN WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 CAPULET DR, ST AUGUSTINE, FL 32092-4537
(904) 429-3859
Mailing address
264 SAINT GEORGE ST, ST AUGUSTINE, FL 32084-5050
(603) 494-4930
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/11/2018
Last updated
07/01/2024
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