Active NPI
Tayler Wittman, M.ED., BCBA
- Behavior Analyst
- Appleton, WI
National Provider Identifier
1184322976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1081-140
- Practice address
- 4797 W Grande Market Dr
Appleton, WI 54913-8411 - Phone
- (920) 815-3873
- NPI assigned
- Feb 21, 2023
- Last updated
- Feb 21, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1081-140 | WI | Primary |
Addresses
Primary practice location
4797 W Grande Market Dr
Appleton, WI 54913-8411
Mailing address
606 E Elm Dr
Little Chute, WI 54140-1276
Phone (715) 600-4081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1081-140 | WI | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nova ABA LLC. | Behavior Analyst | Current | Accepting new patients |
Locations
4797 W Grande Market Dr
Appleton, WI 54913
Phone (920) 470-1677
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1184322976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "606 E ELM DR",
"city": "LITTLE CHUTE",
"state": "WI",
"postal_code": "541401276",
"telephone_number": "715-600-4081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4797 W GRANDE MARKET DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549138411",
"telephone_number": "920-815-3873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTMAN",
"first_name": "TAYLER",
"credential": "M.ED., BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-21",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "1081-140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.