Individual
AMBER WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IS
Contact information
Practice address
312 MAPLE AVE, MIDDLETON, ID 83644-5469
(208) 761-8076
Mailing address
312 MAPLE AVE, MIDDLETON, ID 83644-5469
(208) 761-8076
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0010141
—
ID
Enumeration date
06/13/2022
Last updated
06/13/2022
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