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General NPI Number Information
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NPI Number | 1861851719
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Entity Type | Organization
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Legal Business Name | MAGNITUDE BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 02/21/2016
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Last Update Date | 02/21/2016
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Provider Practice Location Address
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Address Line | 11414 W PARK PL STE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224-3500
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Country | US
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Telephone | 414-460-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 11414 W PARK PL STE 202
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City | MILWAUKEE
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State | WI
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Zip | 53224-3500
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Country | US
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Telephone | 414-460-1445
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JENNIFER L SHARPE-GONZALEZ
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Credential | M.A., BCBA
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Telephone | 414-460-1445
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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 | 110-140
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License Number State | WI
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