Individual
JADE ALEXIS LISOWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6140 W EXECUTIVE DR, MEQUON, WI 53092-4499
(888) 754-0398
Mailing address
1205 ALDER ST, WEST BEND, WI 53090-1707
(262) 336-7086
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
WI
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
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