Melissa Roth Doornek, BCBA
Individual provider Active NPI Behavior Analyst · Delafield, WI
NPI 1013339639 · NPPES record last updated May 3, 2019
Key facts
- NPI
- 1013339639
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 178-140 (WI)
- Practice address
- 3215 Golf Rd Ste 117
Delafield, WI 53018-2157 - Phone
- (262) 672-6882
- NPI assigned
- Jan 16, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178-140 | WI | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 178-140 | WI | Yes |
Addresses
Primary practice location
3215 Golf Rd Ste 117
Delafield, WI 53018-2157
Mailing address
304 Reeds Dr
West Bend, WI 53095-3522
Phone (414) 588-4427
Other practice location 1
2222 S 114th St
West Allis, WI 53227-1031
Phone (414) 963-5940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-17-25167 | Other | BEHAVIOR ANALYST CERTIFICATION BOARD | |
| 178-140 | Other | WI | STATE OF WISCONSIN |
Other providers in Delafield, WI
- Delafield Family Chiropractic LTD
- Delafield Family Dental, Inc
- Delafield Medical Center LLC
- Delafield Vision Center LTD
- Rania Louise Dempsey
- Dr Samy Acupuncture
- Cynthia Dusel
- Rachel B Eddy
- Suzanna Eddy
- Michele Eimon
All providers in Delafield, WI · Behavior Analyst in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.