Provider Demographics
NPI:1104209923
Name:ABA OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:ABA OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-600-2211
Mailing Address - Street 1:1501 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4649
Mailing Address - Country:US
Mailing Address - Phone:715-600-2211
Mailing Address - Fax:630-395-9198
Practice Address - Street 1:1501 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4649
Practice Address - Country:US
Practice Address - Phone:715-600-2211
Practice Address - Fax:630-395-9198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABA OF ILLINOIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-30
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health