Most Relevant Information
Provider Data
| NPI Number: | 1003587221 |
| Provider Name: | NICOLE WENTZ BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | BACB415523 |
Most Important Dates
| Enumeration Date: | 09/27/2021 |
| Last Updated: | 09/27/2021 |
Provider Practice Location
6203 SAN IGNACIO AVE
SAN JOSE
CA
951191371
Practice Location Phone/Fax
| Phone: | 4158378017 |
| Fax: |
Provider Mailing Location
7108 S KANNER HWY
STUART
FL
349977462
Provider Mailing Phone/Fax
| Phone: | 4158378017 |
| Fax: |