Provider Demographics
NPI:1427660463
Name:LEWIS, ERICA P (BCBA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:P
Last Name:LEWIS
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 1:916 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2615
Mailing Address - Country:US
Mailing Address - Phone:920-207-4083
Mailing Address - Fax:
Practice Address - Street 1:575 DONOFRIO DR STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2832
Practice Address - Country:US
Practice Address - Phone:608-512-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI386-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst