| Sunrise Aba Of Wisconsin, Llc | |
|
6580 Monona Dr # 1173 Monona WI 53716-4032 | |
| (628) 250-7500 | |
| Not Available |
| Full Name | Sunrise Aba Of Wisconsin, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 6580 Monona Dr # 1173, Monona, Wisconsin |
| Authorized Official Name and Position | Brady Keith (CEO) |
| Authorized Official Contact | 6282507500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Aba Of Wisconsin, Llc 505 San Marin Dr Ste 100b Novato CA 94945-1309 Ph: () - | Sunrise Aba Of Wisconsin, Llc 6580 Monona Dr # 1173 Monona WI 53716-4032 Ph: (628) 250-7500 |
| NPI Number | 1720788300 |
|---|---|
| Provider Enumeration Date | 03/03/2023 |
| Last Update Date | 03/03/2023 |
| Certification Date | 02/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720788300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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