Provider Demographics
NPI:1639912710
Name:HIRTZ, JACOB DEAN (BCBA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DEAN
Last Name:HIRTZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 S KATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5627
Mailing Address - Country:US
Mailing Address - Phone:262-312-0328
Mailing Address - Fax:
Practice Address - Street 1:6191 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2524
Practice Address - Country:US
Practice Address - Phone:414-475-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst