Individual
PHILLIP STUTZMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
4125 N 124TH ST STE A, BROOKFIELD, WI 53005-1837
(414) 763-2341
Mailing address
6720 W ENGLISH MEADOWS DR APT K104, GREENFIELD, WI 53220-3978
(414) 828-7778
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
201-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100050272
—
WI
Enumeration date
12/03/2017
Last updated
12/03/2017
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