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Individual

MRS. LISA MARIE ELLICKSON-ALBERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, BCBA

Contact information

Practice address
1542 INDUSTRIAL DR, SHAWANO, WI 54166-3842
(715) 916-3889
Mailing address
106 LINCOLN AVE, CLINTONVILLE, WI 54929-1352
(920) 224-5048

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB711387
103K00000X
Behavior Analyst
WI

Other

Enumeration date
05/08/2023
Last updated
05/08/2023
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