Healthcare Provider Details

I. General information

NPI: 1255661120
Provider Name (Legal Business Name): REACHING YOUR POTENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 06/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 RUDY STREET
ONALASKA WI
54650-8580
US

IV. Provider business mailing address

W11191 HAGEN LANE
BLACK RIVER FALLS WI
54615-5994
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-4668
  • Fax: 715-670-0775
Mailing address:
  • Phone: 715-299-4668
  • Fax: 715-670-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2328-57
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACEY A COWLEY
Title or Position: CO-OWNER, BEHAVIOR ANALYST
Credential: BCBA
Phone: 715-299-4668