Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 243-140 | WI |
NPI | 1003392945 |
---|---|
Provider Name | Melissa Gerber |
First Address | Stoughton, WI 53589-2035 |
Second Address | Madison, WI 53713-2934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 07/05/2019 |