Healthcare Provider Details

I. General information

NPI: 1013424985
Provider Name (Legal Business Name): EMILY MARIE NEVEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 SKYLINE DR
CEDARBURG WI
53012-9397
US

IV. Provider business mailing address

5720 N 93RD ST
MILWAUKEE WI
53225-2711
US

V. Phone/Fax

Practice location:
  • Phone: 262-385-5907
  • Fax:
Mailing address:
  • Phone: 906-396-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number317-140
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0177825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: