Individual
AMBER WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 MEADOWLANDS DR, WHITE BEAR LAKE, MN 55127-2339
(612) 315-1976
Mailing address
43 116TH AVE NE, BLAINE, MN 55434-7823
(763) 439-5021
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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