Individual
AMANDA GRACE PRUSOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1155 QUAIL CT STE 100, PEWAUKEE, WI 53072-3780
(262) 404-6153
Mailing address
2017 WOLF RD, WAUKESHA, WI 53186-2639
(920) 889-6510
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1282-140
WI
Other
Enumeration date
06/02/2022
Last updated
10/28/2024
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