Individual
LYDIA F WEISMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4959 UTICA RIDGE RD, DAVENPORT, IA 52807-3063
(785) 313-0324
Mailing address
4959 UTICA RIDGE RD, DAVENPORT, IA 52807-3063
(785) 313-0324
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-166374
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-21-166374
BACB
IL
Enumeration date
09/02/2021
Last updated
09/02/2021
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