| Fox Valley Autism Treatment Program | |
|
W556 Wrightstown Rd Kaukauna WI 54130-9701 | |
| (920) 205-0475 | |
| Not Available |
| Full Name | Fox Valley Autism Treatment Program |
|---|---|
| Speciality | Behavior Analyst |
| Location | W556 Wrightstown Rd, Kaukauna, Wisconsin |
| Authorized Official Name and Position | Staci Ferg (PRESIDENT) |
| Authorized Official Contact | 9202050475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox Valley Autism Treatment Program W556 Wrightstown Rd Kaukauna WI 54130-9701 Ph: (920) 205-0475 | Fox Valley Autism Treatment Program W556 Wrightstown Rd Kaukauna WI 54130-9701 Ph: (920) 205-0475 |
| NPI Number | 1336648666 |
|---|---|
| Provider Enumeration Date | 02/01/2018 |
| Last Update Date | 02/01/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336648666 | NPI | - | NPPES |
| 100059553 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 152-140 (Wisconsin) | Primary |
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