Individual
TAMARA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2419 RAY WEILAND DR, BAKER, LA 70714-3227
(225) 245-2182
Mailing address
2419 RAY WEILAND DR, BAKER, LA 70714-3227
(225) 245-2182
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112252263
—
LA
Enumeration date
01/25/2022
Last updated
12/05/2022
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