Active NPI
Joline Mutz
- Behavior Analyst
- Cedarburg, WI
National Provider Identifier
1710469812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 246-140
- Practice address
- 1575 Skyline Dr
Cedarburg, WI 53012-9397 - Phone
- (414) 847-5722
- Fax
- (414) 443-5722
- NPI assigned
- Sep 5, 2018
- Last updated
- Sep 5, 2018
- 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 | 246-140 | WI | Primary |
Addresses
Primary practice location
1575 Skyline Dr
Cedarburg, WI 53012-9397
Mailing address
1575 Skyline Dr
Cedarburg, WI 53012-9397
Phone (414) 847-5722
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246-140 | WI | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1710469812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 SKYLINE DR",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129397",
"telephone_number": "414-847-5722",
"fax_number": "414-443-5722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 SKYLINE DR",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129397",
"telephone_number": "414-847-5722",
"fax_number": "414-443-5722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTZ",
"first_name": "JOLINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WI",
"license": "246-140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedarburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.