Provider Demographics
NPI:1225392608
Name:JUZWIK, SUZANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JUZWIK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2829
Mailing Address - Country:US
Mailing Address - Phone:310-488-2814
Mailing Address - Fax:
Practice Address - Street 1:W4874 EDELWEISS RD
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9304
Practice Address - Country:US
Practice Address - Phone:480-242-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-11467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst