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NPI Code Detail

MEDICARE: CARRIE WINGERT M.S., BCBA

MEDICARE: CARRIE WINGERT M.S., BCBA
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
1103K00000XBehavior Analyst39-140WI

General Provider Information

NPI Number : 1063967990
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE WINGERT M.S., BCBA
Provider Business Mailing Address
First Line : 303 HONEYCRISP DR
Second Line :
City : BEAVER DAM
State : WI
Zip : 53916-9256
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 559 ZOR SHRINE PL
Second Line :
City : MADISON
State : WI
Zip : 53719-2068
Country : US
Telephone Number : 608-441-0123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2016
Last Update Date : 08/21/2016

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