Individual
ANGELA FELLENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
371 E 1ST ST, FOND DU LAC, WI 54935-4563
(920) 907-3967
Mailing address
W2427 SNOWBERRY DR, APPLETON, WI 54915-7484
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1138-140
WI
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
0-20-11369
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-20-11369
BACB CERTIFICATION #
WI
01
—
1-23-67656
BEHAVIOR ANALYSIS CERTIFICATION BOARD
—
01
—
1138-140
STATE OF WISCONSIN DIRECT LICENSING DEPT. OF SAFETY AND PROFESSIONAL SERVICES
WI
Enumeration date
09/30/2020
Last updated
09/12/2023
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