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NPI Code Detail

MEDICARE: MACIE BROGAN

MEDICARE: MACIE BROGAN
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1861165516
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACIE BROGAN
Provider Business Mailing Address
First Line : W3272 STARDUST LN
Second Line :
City : SHEBOYGAN FALLS
State : WI
Zip : 53085-2417
Country : US
Telephone Number : 920-645-7606
Fax Number :
Provider Business Practice Location Address
First Line : 905 S TAYLOR DR
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-4766
Country : US
Telephone Number : 920-710-6867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2021
Last Update Date : 12/20/2024

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Directions to “ MACIE BROGAN ” Practice Location

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