Provider Demographics
NPI:1679340020
Name:PEREZ-GUERRA, CARLIE (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:PEREZ-GUERRA
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9124
Mailing Address - Country:US
Mailing Address - Phone:608-497-3230
Mailing Address - Fax:
Practice Address - Street 1:200 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9124
Practice Address - Country:US
Practice Address - Phone:608-497-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-69430103K00000X
WI1171-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst