Ethan Wick
Behavior Technician in Jacksonville, FL. Individual provider (NPI-1).
NPI number1053132001
StatusActive
Last updated in NPPESOct 22, 2024
Details
- NPI
- 1053132001
- Entity type
- Individual (NPI-1)
- Name
- Ethan Wick
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 22, 2024
- Certification date
- Oct 22, 2024
- Last updated
- Oct 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Other names
- Ethan Lynch Wick (Other Name)
Practice location
12724 Gran Bay Pkwy W Ste 410Jacksonville, FL 32258-9486
Phone 855-832-6727
Mailing address
7108 S Kanner HwyStuart, FL 34997-7462
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