Organization
FOX VALLEY AUTISM TREATMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI FERG (PRESIDENT)
(920) 205-0475
Entity
Organization
Contact information
Practice address
W556 WRIGHTSTOWN RD, KAUKAUNA, WI 54130-9701
(920) 205-0475
Mailing address
W556 WRIGHTSTOWN RD, KAUKAUNA, WI 54130-9701
(920) 205-0475
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
152-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059553
—
WI
Enumeration date
02/01/2018
Last updated
02/01/2018
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