Provider Demographics
NPI:1295562114
Name:CHAIN OF LAKES ABA LLC
Entity type:Organization
Organization Name:CHAIN OF LAKES ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEVEU
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:906-396-5901
Mailing Address - Street 1:E1775 GARFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-8213
Mailing Address - Country:US
Mailing Address - Phone:906-396-5901
Mailing Address - Fax:
Practice Address - Street 1:E1775 GARFIELD LN
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-8213
Practice Address - Country:US
Practice Address - Phone:906-396-5901
Practice Address - Fax:715-318-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty