Individual
KAITLYN WYNECOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5266 SENECA ST, WEST SENECA, NY 14224-3707
(818) 241-6780
Mailing address
1055 E COLORADO BLVD STE 560, PASADENA, CA 91106-2380
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
NY
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DCZ75960X00
—
NY
Enumeration date
11/01/2021
Last updated
11/01/2021
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