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1174090484 NPI number — ROGER KYLE CALDWELL-CHADWICK MS, BCBA, LBA, CSAC

NPI Number: 1174090484
Health Care Provider/Practitioner: ROGER KYLE CALDWELL-CHADWICK MS, BCBA, LBA, CSAC

Information about “1174090484” NPI (ROGER KYLE CALDWELL-CHADWICK MS, BCBA, LBA, CSAC) exists in 1174090484 in HTML format HTML  |  1174090484 in plain Text format TXT  |  1174090484 in PDF (Portable Document Format) PDF  |  1174090484 in an XML format XML  formats.

NPI Number : 1174090484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174090484",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CALDWELL-CHADWICK",
    "FirstName": "ROGER",
    "MiddleName": "KYLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, BCBA, LBA, CSAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "720 N OLD WORLD 3RD ST APT 1103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MILWAUKEE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53203-2242",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-902-3932",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11121 W OKLAHOMA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST ALLIS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53227-4033",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-641-9790",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/25/2018",
    "LastUpdateDate": "09/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "253-140",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "17123-132",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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