Individual
TRISHA A IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HS-BCP
Contact information
Practice address
2938 ELM ST, EAST TROY, WI 53120-1223
(262) 203-0014
Mailing address
2938 ELM ST, EAST TROY, WI 53120-1223
(262) 203-0014
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
04/11/2024
Last updated
04/11/2024
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