Individual
AMANDA WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3216 BALLARD LN, NEW ALBANY, IN 47150-7200
(812) 590-2157
(812) 645-3936
Mailing address
3216 BALLARD LN, NEW ALBANY, IN 47150-7200
(812) 590-2157
(812) 645-3936
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-107633
IN
Other
Enumeration date
01/02/2020
Last updated
01/02/2020
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