Individual
ETHAN YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
8700 E 29TH ST N, WICHITA, KS 67226-2169
(316) 634-8710
Mailing address
8700 E 29TH ST N, WICHITA, KS 67226-2169
(316) 634-8710
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201146730C
—
KS
Enumeration date
09/08/2016
Last updated
04/06/2021
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