Provider Demographics
NPI:1619400850
Name:KURTZ, TAMARA MAE (BCBA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MAE
Last Name:KURTZ
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 1:986 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-8818
Mailing Address - Country:US
Mailing Address - Phone:920-544-4870
Mailing Address - Fax:
Practice Address - Street 1:986 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-8818
Practice Address - Country:US
Practice Address - Phone:920-544-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-17-25614103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst