Individual
AMANDA RENEE WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 W JUBAL EARLY DR STE C, WINCHESTER, VA 22601-6501
(884) 244-1818
Mailing address
100 FUZZY TAIL DR, RANSON, WV 25438-4885
(571) 432-6780
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/06/2020
Last updated
07/06/2020
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