Provider Demographics
NPI:1457972382
Name:IGNARSKI, DANA MARIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:IGNARSKI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:MOLDENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7329 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4218
Mailing Address - Country:US
Mailing Address - Phone:262-220-2666
Mailing Address - Fax:
Practice Address - Street 1:10450 72ND AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2911
Practice Address - Country:US
Practice Address - Phone:262-657-6453
Practice Address - Fax:262-671-5013
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI357-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI357-140Medicaid