Healthcare Provider Details

I. General information

NPI: 1033749247
Provider Name (Legal Business Name): ALEIGH WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WHALEN RD
VERONA WI
53593-1765
US

IV. Provider business mailing address

901 WHALEN RD
VERONA WI
53593-1765
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 855-444-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1210-140
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-102576
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: