Individual
MAKYNNA JOYCE WICKWIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 S ELMER AVE, SAYRE, PA 18840-2019
(607) 742-9752
Mailing address
2760 MERCUR HILL RD, WYSOX, PA 18854-7898
(607) 232-6669
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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