Provider Demographics
NPI:1407156474
Name:NORMAN, KAREN RENEE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-3506
Mailing Address - Country:US
Mailing Address - Phone:715-852-0112
Mailing Address - Fax:715-852-0112
Practice Address - Street 1:2028 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-3506
Practice Address - Country:US
Practice Address - Phone:715-852-0112
Practice Address - Fax:715-852-0112
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6-140OtherDEPARTMENT OF REGULATION AND LICENSING