Healthcare Provider Details

I. General information

NPI: 1316454663
Provider Name (Legal Business Name): CATHERINE WISE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE TIONA

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CORPORATE DR STE R
JOHNSTON IA
50131-1659
US

IV. Provider business mailing address

20 LAKEFOREST TRL
SANFORD NC
27332-1046
US

V. Phone/Fax

Practice location:
  • Phone: 515-379-6475
  • Fax:
Mailing address:
  • Phone: 719-342-2841
  • Fax: 515-644-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: