Individual
JOHN MICHAEL WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(804) 614-5853
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
(804) 614-5853
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-115537
ID
Other
Enumeration date
03/13/2020
Last updated
03/13/2020
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