Individual
HEATHER WILFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
901 DOMINION DR STE A, HUDSON, WI 54016-9333
(715) 808-8555
Mailing address
16113 71ST LN NE, OTSEGO, MN 55330-4626
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
272-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272-140
WISCONSIN PROFESSIONAL LICENSE/CREDENTIAL
WI
Enumeration date
12/21/2018
Last updated
12/21/2018
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