MEDICARE: KAITLIN FOGELTANZ 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
1	103K00000X	Behavior Analyst	1037-140	WI

General Provider Information

NPI Number	:	1235852815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN FOGELTANZ BCBA

Provider Business Mailing Address
First Line	:	224 W 35TH ST STE 500
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10400 N BAEHR RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-4472
Country	:	US
Telephone Number	:	414-944-1511
Fax Number	:

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	12/17/2025

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