Individual
SELENA JAZMIN RIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
10930 W POTTER RD, WAUWATOSA, WI 53226-3450
(262) 200-0900
Mailing address
3405 N BROOKFIELD RD, BROOKFIELD, WI 53045-2520
(262) 573-1046
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-151119
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-21-151119
RBT
WI
Enumeration date
08/25/2021
Last updated
08/25/2021
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