Lauren Michelle Debertin

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

459-140 Issued in WI

Practice address

6191 S 108TH St Ste B
Hales Corners, WI 53130-2524

Phone

(414) 475-1896

Fax

(414) 988-9764

NPI assigned

Oct 27, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Treatment for Children, LLC

  • Community/Behavioral Health Agency
  • New Berlin, WI
  • NPI 1952613069
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1508520396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6191 S 108TH ST STE B",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302524",
            "telephone_number": "414-475-1896",
            "fax_number": "414-988-9764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6191 S 108TH ST STE B",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531302524",
            "telephone_number": "414-475-1896",
            "fax_number": "414-988-9764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBERTIN",
        "first_name": "LAUREN",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "459-140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100087705",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.