Organization
SKYLIGHT AUTISM CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS LEGENZA BCBA (OWNER/CLINICAL DIRECTOR)
(715) 571-1566
Entity
Organization
Contact information
Practice address
4601 CAMP PHILLIPS RD, WESTON, WI 54476-1572
(715) 571-1566
Mailing address
7505 GUSMAN RD, SCHOFIELD, WI 54476-2109
(715) 571-1566
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24748
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679018022
—
WI
Enumeration date
06/28/2018
Last updated
06/28/2018
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