Provider Demographics
NPI:1760088298
Name:SCOTT, ALYSSA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SCOTT
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 1:1575 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9397
Mailing Address - Country:US
Mailing Address - Phone:414-847-5722
Mailing Address - Fax:414-433-5722
Practice Address - Street 1:1575 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9397
Practice Address - Country:US
Practice Address - Phone:414-847-5722
Practice Address - Fax:414-433-5722
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI402-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100100752Medicaid