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General NPI Number Information
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NPI Number | 1104273044
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Entity Type | Organization
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Legal Business Name | STARLIGHT CENTERS FOR INCLUSION INC.
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 555 ENTERPRISE WAY
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City | EAGLE RIVER
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State | WI
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Zip | 54521-5504
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Country | US
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Telephone | 608-317-6711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | WOODRUFF
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State | WI
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Zip | 54568-0351
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | APRIL LEANNA
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Credential | MS, BCBA
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Telephone | 608-317-6711
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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 | 81140
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License Number State | WI
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