Healthcare Provider Details

I. General information

NPI: 1184398554
Provider Name (Legal Business Name): ALLISON VILLENEUVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 W BELTLINE HWY STE 300
MADISON WI
53713-2934
US

IV. Provider business mailing address

1161 LAKE COOK RD
DEERFIELD IL
60015-5649
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-6810
  • Fax: 608-819-6811
Mailing address:
  • Phone: 847-498-5437
  • Fax: 847-498-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1186-140
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-152003
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: