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NPI Code Detail

MEDICARE: TAWNA WILEY

MEDICARE: TAWNA WILEY
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 Analyst1-21-49686

General Provider Information

NPI Number : 1639672769
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAWNA WILEY
Provider Business Mailing Address
First Line : 5050 LAGUNA BLVD STE 112
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-4151
Country : US
Telephone Number : 540-993-3422
Fax Number :
Provider Business Practice Location Address
First Line : 5063 MAPLE RD
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-9468
Country : US
Telephone Number : 540-993-3422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2018
Last Update Date : 05/15/2024

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Directions to “ TAWNA WILEY ” Practice Location

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