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General NPI Number Information
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NPI Number | 1306662770
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Entity Type | Individual
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Provider Name | ELISE JORDEN EBERHADRY
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 3722 BRIDLE RD
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City | WARRENS
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State | WI
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Zip | 54666-7610
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Country | US
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Telephone | 608-696-9325
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Fax | 608-506-1114
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Provider Business Mailing Address
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Address Line | 3722 BRIDLE RD
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City | WARRENS
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State | WI
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Zip | 54666-7610
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Country | US
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Telephone | 651-442-3402
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Fax | 608-506-1114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | WI
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