Provider Demographics
NPI:1053681064
Name:MCGOLDRICK, AMELIA C (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:C
Last Name:MCGOLDRICK
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N88W17105 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2025
Mailing Address - Country:US
Mailing Address - Phone:262-422-0707
Mailing Address - Fax:
Practice Address - Street 1:N88W17105 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2025
Practice Address - Country:US
Practice Address - Phone:262-422-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst