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General NPI Number Information
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NPI Number | 1164807665
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Entity Type | Organization
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Legal Business Name | ADVANCING ABILITIES OF WISCONSIN
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Dates
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Enumeration Date | 07/25/2015
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Last Update Date | 07/25/2015
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Provider Practice Location Address
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Address Line | 10909 W GREENFIELD AVE SUITE 207
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City | WEST ALLIS
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State | WI
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Zip | 53214-2379
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Country | US
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Telephone | 262-707-3257
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Fax | 877-565-8884
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Provider Business Mailing Address
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Address Line | 10909 W GREENFIELD AVE SUITE 207
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City | WEST ALLIS
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State | WI
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Zip | 53214-2379
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Country | US
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Telephone | 262-707-3257
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Fax | 877-565-8884
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF CLINICAL OFFICE
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Name | MS. RHONDA JEAN GREENHAW
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Credential | BCBA
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Telephone | 262-707-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 20-140
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License Number State | WI
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