Individual
JERYN LEE WALDERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
458 COULEE TRL, HUDSON, WI 54016-8156
(715) 410-1182
Mailing address
458 COULEE TRL, HUDSON, WI 54016-8156
(715) 410-1182
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-17917
BCBA CERTIFICATION
—
Enumeration date
04/16/2015
Last updated
04/16/2015
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