Individual
MRS. STACEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., BCBA
Contact information
Practice address
8324 CEDAR CHASE DR, FOUNTAIN, CO 80817-4030
(940) 368-7105
Mailing address
8324 CEDAR CHASE DR, FOUNTAIN, CO 80817-4030
(940) 368-7105
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-15649
—
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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