Provider Demographics
NPI:1144764127
Name:ADVANCING ABILITIES OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:ADVANCING ABILITIES OF WISCONSIN, LLC
Other - Org Name:ADVANCING ABILITIES OF WISCONSIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CHIEF CLINICAL OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:414-259-0021
Mailing Address - Street 1:10909 W GREENFIELD AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2379
Mailing Address - Country:US
Mailing Address - Phone:414-259-0021
Mailing Address - Fax:844-315-9207
Practice Address - Street 1:10909 W GREENFIELD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2379
Practice Address - Country:US
Practice Address - Phone:414-259-0021
Practice Address - Fax:844-315-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-140251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health