Individual
BAILEY WAITS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Mailing address
3820 FAIRFIELD AVE UNIT 118, SHREVEPORT, LA 71104-4745
(903) 987-9382
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-329597
LA
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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