Provider Demographics
NPI:1710374830
Name:WIJSEN, ANDREA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WIJSEN
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 1:1942 EMBARCADERO
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5213
Mailing Address - Country:US
Mailing Address - Phone:510-832-4383
Mailing Address - Fax:510-550-1981
Practice Address - Street 1:1942 EMBARCADERO
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5213
Practice Address - Country:US
Practice Address - Phone:510-832-4383
Practice Address - Fax:510-550-1981
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-13-14403103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst