Provider Demographics
NPI:1558082628
Name:DOFFEK, KORI DANIELLE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:DANIELLE
Last Name:DOFFEK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 W POTTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3450
Mailing Address - Country:US
Mailing Address - Phone:262-501-8861
Mailing Address - Fax:
Practice Address - Street 1:10930 W POTTER RD STE A
Practice Address - Street 2:
Practice Address - City:WAUWATOSA.
Practice Address - State:WI
Practice Address - Zip Code:53226-3450
Practice Address - Country:US
Practice Address - Phone:262-200-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1033-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst