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General NPI Number Information
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NPI Number | 1053227769
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Entity Type | Individual
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Provider Name | JACOB WISOR
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Gender | Male
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 314 LAUREL OAKS DR
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-2099
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Country | US
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Telephone | 185-583-2672
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Fax |
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Provider Business Mailing Address
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Address Line | 9816 N OLDE TOWNE WYND SE
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City | LELAND
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State | NC
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Zip | 28451-8411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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