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General NPI Number Information
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NPI Number | 1033815592
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Entity Type | Organization
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Legal Business Name | GROVE BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | N590 RABBIT RD
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City | FREMONT
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State | WI
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Zip | 54940-9503
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Country | US
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Telephone | 920-381-9859
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Fax | 930-325-0022
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Provider Business Mailing Address
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Address Line | N590 RABBIT RD
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City | FREMONT
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State | WI
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Zip | 54940-9503
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Country | US
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Telephone | 920-381-9859
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Fax | 930-325-0022
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Authorized Official
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Title or Position | OWNER
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Name | JANELLE MARIE UPTHEGROVE
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Credential | BCBA
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Telephone | 920-381-9859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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