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Individual

STANLEY KEITH WACHOLZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BS BIS

Contact information

Practice address
5723 E DODD RD, HAYDEN LAKE, ID 83835-9376
(208) 651-8985
Mailing address
5723 E DODD RD, HAYDEN LAKE, ID 83835-9376
(208) 651-8985

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
ID
106E00000X
Assistant Behavior Analyst

Other

Enumeration date
09/26/2019
Last updated
09/26/2019
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