MEDICARE: JESSICA POTTINGER BCABA

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	0-26-17149	WI

General Provider Information

NPI Number	:	1548191836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA POTTINGER BCABA

Provider Business Mailing Address
First Line	:	4359 S HOWELL AVE STE 302
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5056
Country	:	US
Telephone Number	:	414-436-3148
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5056
Country	:	US
Telephone Number	:	414-436-3148
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ JESSICA POTTINGER BCABA” Practice Location

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