Healthcare Provider Details

I. General information

NPI: 1609512599
Provider Name (Legal Business Name): CLAIRE A WISTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 12TH ST # 1-0506
TAMPA FL
33602-3100
US

IV. Provider business mailing address

601 N 12TH ST # 1-0506
TAMPA FL
33602-3100
US

V. Phone/Fax

Practice location:
  • Phone: 407-951-4138
  • Fax:
Mailing address:
  • Phone: 407-951-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15864
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-205219
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2826890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: