Provider Demographics
NPI:1215445499
Name:SLAMA, TESSA (BCBA)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:SLAMA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9439
Mailing Address - Country:US
Mailing Address - Phone:608-485-0436
Mailing Address - Fax:
Practice Address - Street 1:1100 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9439
Practice Address - Country:US
Practice Address - Phone:608-485-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst