Individual
PROF. ROGER FRANK BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, BCBA-D
Contact information
Practice address
278 FLORANN DRIVE, FITCHBURG, WI 53711
(262) 853-1951
Mailing address
278 FLORAN DRIVE, FITCHBURG, WI 53711
(262) 853-1951
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
14-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-09-5522
BOARD CERTIFIED BEHAVIOR ANALYST
WI
Enumeration date
03/02/2012
Last updated
03/02/2012
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