Individual
MS. JADINE SANDRA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, BCBA, LBA
Contact information
Practice address
610 MANTON AVE, PROVIDENCE, RI 02909-5633
(401) 263-7829
Mailing address
176 ATLANTIC AVE APT 4, PROVIDENCE, RI 02907-1861
(401) 263-7829
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA00229
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-44001
BACB
—
01
—
LBA00229
DEPARTMENT OF HEALTH
RI
Enumeration date
10/05/2020
Last updated
10/06/2020
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