| NPI | 1982121935 |
|---|---|
| Former Name | KELLY C WIECZOREK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NE 1-21-48102) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2023-01-10 |