NPI 1548811904

Stanley Keith Wacholz, BSBIS

Practitioner Assistant Behavior Analyst Hayden Lake, ID

Practice location

Address: 5723 E Dodd Rd, Hayden Lake, ID 83835-9376
Phone: (208) 651-8985

Registered specialties (2)

Assistant Behavior Analyst Primary

Behavioral Health & Social Service Providers Taxonomy 106E00000X

Other Assistant Behavior Analyst providers in Idaho →

Assistant Behavior Analyst

Behavioral Health & Social Service Providers Taxonomy 106E00000X

Registry record

NPI: 1548811904
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Sep 2019
Record last updated: 26 Sep 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.