Individual
JORDYN KRIS WOHLGEFAHRT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9230 OLD LORRAINE RD, GULFPORT, MS 39503-6059
(228) 731-3500
Mailing address
12464 PINEHURST CT, GULFPORT, MS 39503-7678
(414) 242-8342
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-121919
MS
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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