MEDICARE: WENDY ANN HAUSER BSL

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	BH000507	PA

General Provider Information

NPI Number	:	1740698000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ANN HAUSER BSL

Provider Business Mailing Address
First Line	:	2112 LONG RUN ROAD
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235
Country	:	US
Telephone Number	:	484-629-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 LONG RUN ROAD
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235
Country	:	US
Telephone Number	:	484-629-2224
Fax Number	:

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

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	07/30/2014

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