Individual
AUTUMN LEIGH LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4340 ELM LAWN RD, OCONTO FALLS, WI 54154-9656
(920) 944-9373
Mailing address
4340 ELM LAWN RD, OCONTO FALLS, WI 54154-9656
(715) 330-1773
(920) 260-2023
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
RBT21159367
TX
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/07/2021
Last updated
06/29/2023
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