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General NPI Number Information
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NPI Number | 1720729460
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Entity Type | Individual
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Provider Name | BETHANY PFEIFFER
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 4006 WASHINGTON RD STE A
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City | KENOSHA
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State | WI
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Zip | 53144-4819
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Country | US
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Telephone | 262-204-5697
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Fax |
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Provider Business Mailing Address
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Address Line | 3718 23RD ST
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City | KENOSHA
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State | WI
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Zip | 53144-1478
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Country | US
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Telephone | 262-951-8690
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Fax |
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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 | 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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