Individual
GENNESSA ORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6140 W EXECUTIVE DRIVE, SUITE B, MEQUON, WI 53092-5883
(262) 788-8088
Mailing address
6140 W EXECUTIVE DR STE B, MEQUON, WI 53092-4499
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-119298
WI
Other
Enumeration date
09/14/2021
Last updated
12/04/2023
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