Individual
MELISSA ROTH DOORNEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3215 GOLF RD STE 117, DELAFIELD, WI 53018-2157
(262) 672-6882
Mailing address
304 REEDS DR, WEST BEND, WI 53095-3522
(414) 588-4427
(414) 963-5950
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
178-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-17-25167
BEHAVIOR ANALYST CERTIFICATION BOARD
—
01
—
178-140
STATE OF WISCONSIN
WI
Enumeration date
01/16/2014
Last updated
05/03/2019
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