Provider Demographics
NPI:1821680042
Name:THEISS, GABRIELLA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:THEISS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 WESTON AVE
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-1160
Practice Address - Country:US
Practice Address - Phone:715-204-7570
Practice Address - Fax:715-273-7090
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI412-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst