Provider Demographics
NPI:1770311649
Name:WERNER, MAETHA RENEE (BCBA)
Entity type:Individual
Prefix:
First Name:MAETHA
Middle Name:RENEE
Last Name:WERNER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 HOGANWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOBIESKI
Mailing Address - State:WI
Mailing Address - Zip Code:54171-9521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 AMS CT
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:WI
Practice Address - Zip Code:54313-9704
Practice Address - Country:US
Practice Address - Phone:920-504-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-24-74453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst