| Autism Behavioral Network | |
|
3636 N 124th St 3rd Floor Wauwatosa WI 53222-2125 | |
| (414) 476-9755 | |
| (414) 476-3413 |
| Full Name | Autism Behavioral Network |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 3636 N 124th St, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Tracy R Pritzl (DIRECTOR OWNER) |
| Authorized Official Contact | 4144769755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism Behavioral Network 3636 N 124th St 3rd Floor Wauwatosa WI 53222-2125 Ph: (414) 476-9755 | Autism Behavioral Network 3636 N 124th St 3rd Floor Wauwatosa WI 53222-2125 Ph: (414) 476-9755 |
| NPI Number | 1124193065 |
|---|---|
| Provider Enumeration Date | 11/22/2006 |
| Last Update Date | 09/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124193065 | NPI | - | NPPES |
| 42212500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 613 057 (Wisconsin) | Primary |
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