Individual
AUSTIN I WRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 W TAPP RD, BLOOMINGTON, IN 47403-3459
(715) 529-0679
Mailing address
1501 W TAPP RD, BLOOMINGTON, IN 47403-3459
(715) 529-0679
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-112156
IN
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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