Most Relevant Information
Provider Data
| NPI Number: | 1003304171 |
| Provider Name: | SHANNON WILSON BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 106E00000X |
| Specialty: | Assistant Behavior Analyst |
| License Number: | 01910399 |
Most Important Dates
| Enumeration Date: | 04/24/2018 |
| Last Updated: | 08/04/2021 |
Provider Practice Location
1146 DOGWOOD AVE
TAMPA
FL
336131718
Practice Location Phone/Fax
| Phone: | 8134180528 |
| Fax: |
Provider Mailing Location
4809 EHRLICH RD
TAMPA
FL
336242073
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |