Healthcare Provider Details

I. General information

NPI: 1023445343
Provider Name (Legal Business Name): KASSITY MARIE SENF BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W4874 EDELWEISS RD
NEW GLARUS WI
53574-9304
US

IV. Provider business mailing address

607 S MAIN ST
BLANCHARDVILLE WI
53516-9377
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-8735
  • Fax:
Mailing address:
  • Phone: 608-438-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1235-39
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number48-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: