Individual
MRS. KATHARINE PAGE TACKABERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
1141 W MAIN AVE, 200, DE PERE, WI 54115-9345
(920) 338-1610
Mailing address
1141 W MAIN AVE, 200, DE PERE, WI 54115-9345
(920) 338-1610
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24034
WI
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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