Individual
CHLOE CODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 N PATRICK BLVD STE 250, BROOKFIELD, WI 53045-5883
(888) 754-0398
Mailing address
2363 N 69TH ST, WAUWATOSA, WI 53213-1311
(414) 366-3246
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
WI
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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