Provider Demographics
NPI:1184281289
Name:WEDELL, RENEE ESTHER (BCBA)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ESTHER
Last Name:WEDELL
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 1:268 BUSH ST STE 3039
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3503
Mailing Address - Country:US
Mailing Address - Phone:408-308-6629
Mailing Address - Fax:
Practice Address - Street 1:268 BUSH ST STE 3039
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3503
Practice Address - Country:US
Practice Address - Phone:408-308-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty