| Skylight Autism Center | |
|
4601 Camp Phillips Rd Weston WI 54476-1572 | |
| (715) 571-1566 | |
| Not Available |
| Full Name | Skylight Autism Center |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4601 Camp Phillips Rd, Weston, Wisconsin |
| Authorized Official Name and Position | Alexis Legenza (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 7155711566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Skylight Autism Center 7505 Gusman Rd Schofield WI 54476-2109 Ph: (715) 571-1566 | Skylight Autism Center 4601 Camp Phillips Rd Weston WI 54476-1572 Ph: (715) 571-1566 |
| NPI Number | 1801381173 |
|---|---|
| Provider Enumeration Date | 06/28/2018 |
| Last Update Date | 06/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801381173 | NPI | - | NPPES |
| 1679018022 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-16-24748 (Wisconsin) | Primary |
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