Individual
KELLEY T WASSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
462 HEGEMAN AVE, COLCHESTER, VT 05446-3187
(207) 239-8603
Mailing address
21600 OXNARD ST, WOODLAND HILLS, CA 91367-4976
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
73083265
VT
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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