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NPI Code Detail

MEDICARE: GREAT LAKES BEHAVIOR ANALYSIS, INC.

MEDICARE: GREAT LAKES BEHAVIOR ANALYSIS, INC.
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 Analyst28-140WI

General Provider Information

NPI Number : 1881049864
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES BEHAVIOR ANALYSIS, INC.
Provider Business Mailing Address
First Line : 3238 S 16TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4535
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3238 S 16TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4535
Country : US
Telephone Number : 414-847-5722
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DANIELLE DELLER
Credential :
Telephone Number : 262-385-5907
Provider Enumeration Date : 04/27/2016
Last Update Date : 09/22/2025

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