Most Relevant Information
Provider Data
| NPI Number: | 1003302431 |
| Provider Name: | RAVEN MICHELLE WILSON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/09/2018 |
| Last Updated: | 07/09/2018 |
Provider Practice Location
400 29TH ST STE 204
OAKLAND
CA
946093547
Practice Location Phone/Fax
| Phone: | 5106793545 |
| Fax: |
Provider Mailing Location
400 29TH ST STE 204
OAKLAND
CA
946093547
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |