Individual
MADELINE MARJORIE BELISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BASC RBT
Contact information
Practice address
1827 WYOMING AVE, SUPERIOR, WI 54880-2209
(952) 767-4200
(952) 767-4211
Mailing address
5860 BAKER RD, MINNETONKA, MN 55345-5903
(952) 767-4200
(952) 767-4211
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-25-414298
BACB
—
Enumeration date
03/19/2025
Last updated
03/19/2025
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