MEDICARE: XIAOLI WEN M.S. BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-05-2471

General Provider Information

NPI Number	:	1285870956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAOLI WEN M.S. BCBA

Provider Business Mailing Address
First Line	:	9804 MADELAINE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4918
Country	:	US
Telephone Number	:	410-979-7999
Fax Number	:	410-480-8281

Provider Business Practice Location Address
First Line	:	9804 MADELAINE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4918
Country	:	US
Telephone Number	:	410-979-7999
Fax Number	:	410-480-8281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	12/30/2008

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