Healthcare Provider Details

I. General information

NPI: 1548191836
Provider Name (Legal Business Name): JESSICA POTTINGER BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 S HOWELL AVE
MILWAUKEE WI
53207-5056
US

IV. Provider business mailing address

4359 S HOWELL AVE STE 302
MILWAUKEE WI
53207-5056
US

V. Phone/Fax

Practice location:
  • Phone: 414-436-3148
  • Fax:
Mailing address:
  • Phone: 414-436-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-17149
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: