Provider Demographics
NPI:1518396696
Name:KING, ALLISON MARIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:HENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:105 N WHITNEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2718
Mailing Address - Country:US
Mailing Address - Phone:608-960-4540
Mailing Address - Fax:
Practice Address - Street 1:105 N WHITNEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2718
Practice Address - Country:US
Practice Address - Phone:608-960-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI113-440OtherSTATE LICENSE
1-13-14596OtherBEHAVIOR ANALYST CERTIFICATION BOARD - BCBA CERTIFICATION