Individual
ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(307) 257-5487
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
(307) 257-5487
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT2162193
WY
106S00000X
Behavior Technician
—
—
Other
Enumeration date
04/12/2017
Last updated
03/30/2021
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