Provider Demographics
NPI:1396301495
Name:WYLIE, ERIN (BCBA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 W ELFINDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1295
Mailing Address - Country:US
Mailing Address - Phone:417-874-1906
Mailing Address - Fax:417-874-1906
Practice Address - Street 1:1721 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1295
Practice Address - Country:US
Practice Address - Phone:417-874-1906
Practice Address - Fax:417-874-1906
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst