Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 264-140 | WI |
NPI | 1013209279 |
---|---|
Provider Name | Amy Catherine Koglin |
First Address | Hartland, WI 53029-2911 |
Second Address | Rhinelander, WI 54501-3918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 21/01/2021 |