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NPI Code Detail

MEDICARE: HEATHER WYATT

MEDICARE: HEATHER WYATT
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
1103K00000XBehavior Analyst7401001458
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1235605767
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER WYATT
Provider Business Mailing Address
First Line : 1256 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4067
Country : US
Telephone Number : 616-248-5154
Fax Number : 616-719-1184
Provider Business Practice Location Address
First Line : 1256 WALKER AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4067
Country : US
Telephone Number : 616-248-5154
Fax Number : 616-719-1184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2018
Last Update Date : 06/05/2026

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Directions to “ HEATHER WYATT ” Practice Location

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