Healthcare Provider Details

I. General information

NPI: 1669381414
Provider Name (Legal Business Name): MATTHEW DANIEL TALAMO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 HEALY DR
WILLIAMS BAY WI
53191-9727
US

IV. Provider business mailing address

89 HEALY DR
WILLIAMS BAY WI
53191-9727
US

V. Phone/Fax

Practice location:
  • Phone: 630-639-7935
  • Fax:
Mailing address:
  • Phone: 630-639-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: