Healthcare Provider Details

I. General information

NPI: 1871088179
Provider Name (Legal Business Name): BETH VAN HOUTEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH MONTICK

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
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 Number262-140
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-16-7017
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: