Individual
LAURIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16331 HERITAGE PL STE 101, EAGLE RIVER, AK 99577-7753
(907) 350-8893
Mailing address
PO BOX 670441, CHUGIAK, AK 99567-0441
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
153608
AK
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/11/2017
Last updated
01/30/2020
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