Individual
MICHELLE WIETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15911 NACOGDOCHES RD BLDG 1, SAN ANTONIO, TX 78247-1107
(210) 599-7733
Mailing address
6323 SILVER FOX, SAN ANTONIO, TX 78247-1100
(210) 482-0217
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
4240
TX
106S00000X
Behavior Technician
RBT-16-13391
—
Other
Enumeration date
11/06/2019
Last updated
07/13/2021
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