Individual
KANDRA RAE WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA BCBA BHP
Contact information
Practice address
1830 S ALMA SCHOOL RD STE 130, MESA, AZ 85210-3088
(602) 510-5401
Mailing address
1848 N 52ND ST, PHOENIX, AZ 85008-3402
(602) 510-5401
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BA-0258
AZ
Other
Enumeration date
12/14/2016
Last updated
12/14/2016
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