Organization
WI MC SPROUT LLC
Active
Other names
Sprout Therapy, Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK MD (OWNER)
(833) 384-7193
Entity
Organization
Contact information
Practice address
11414 W PARK PL STE 202, MILWAUKEE, WI 53224-3500
(833) 991-2368
(929) 384-7193
Mailing address
11414 W PARK PL STE 202, MILWAUKEE, WI 53224-3500
(833) 991-2368
(929) 384-7193
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/16/2021
Last updated
09/27/2021
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