MEDICARE: SPECTRUM OF INDEPENDENCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750233029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM OF INDEPENDENCE, LLC

Provider Business Mailing Address
First Line	:	3980 S LAKE DR APT 13
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-5244
Country	:	US
Telephone Number	:	715-697-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 S LAKE DR APT 13
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-5244
Country	:	US
Telephone Number	:	715-697-8926
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	ELIZABETH VERONICA HINTZ
Credential	:
Telephone Number	:	715-697-8926

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	04/15/2026

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