Individual
LAUREL JEAN WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4432 CAVE SPRING RD SW, ROME, GA 30161-3776
(801) 427-5144
Mailing address
4432 CAVE SPRING RD SW, ROME, GA 30161-3776
(801) 427-5144
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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