Blaise Wilson

NPI #1023776176 in Commerce City, Colorado

Provider Information

NPI Number: 1023776176
Entity Type: Individual
Name: Blaise Wilson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 6, 2021
Last Updated: Dec 6, 2021

Practice Location

Address: 12303 E 104TH PL UNIT 105
City: Commerce City
State: Colorado
ZIP Code: 80022-2098
Phone: (720) 642-7019

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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