Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 178-140 | WI |
NPI | 1013339639 |
---|---|
Provider Name | Melissa Roth Doornek |
First Address | West Bend, WI 53095-3522 |
Second Address | Delafield, WI 53018-2157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-17-25167 | BEHAVIOR ANALYST CERTIFICATION BOARD (01) | |
178-140 | STATE OF WISCONSIN (01) | WI |