MEDICARE: AMANI ROBERTSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		WI

General Provider Information

NPI Number	:	1003770728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANI ROBERTSON

Provider Business Mailing Address
First Line	:	7063 N 37TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 W EXECUTIVE DR STE B
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-4499
Country	:	US
Telephone Number	:	888-740-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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