MEDICARE: SHAWN MCCABE

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	1193-140	WI

General Provider Information

NPI Number	:	1902660137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MCCABE

Provider Business Mailing Address
First Line	:	745 S VAN BUREN ST
Second Line	:
City	:	STOUGHTON
State	:	WI
Zip	:	53589-2398
Country	:	US
Telephone Number	:	608-572-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 MIDLAND RD
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53546-2332
Country	:	US
Telephone Number	:	608-352-6627
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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