Healthcare Provider Details

I. General information

NPI: 1831556182
Provider Name (Legal Business Name): KIMBERLY JOY WUNSCHEL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY JOY KLEWIN

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 FOURIER DR SUITE #100
MADISON WI
53717-1969
US

IV. Provider business mailing address

1210 FOURIER DR SUITE #100
MADISON WI
53717-1969
US

V. Phone/Fax

Practice location:
  • Phone: 608-662-9327
  • Fax: 608-662-9041
Mailing address:
  • Phone: 608-662-9327
  • Fax: 608-662-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number135-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: