MEDICARE: MS. ALANA AMERIE WIDEMAN

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

General Provider Information

NPI Number	:	1821954447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALANA AMERIE WIDEMAN

Provider Business Mailing Address
First Line	:	3750 E PALM VALLEY BLVD UNIT 44
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 N RED BUD LN
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3441
Country	:	US
Telephone Number	:	915-249-8837
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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