Provider Demographics
NPI:1700750569
Name:EMPOWERED GROWTH LLC
Entity type:Organization
Organization Name:EMPOWERED GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DESANCTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:414-477-0513
Mailing Address - Street 1:4645 S DELPHINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6631
Mailing Address - Country:US
Mailing Address - Phone:414-477-0513
Mailing Address - Fax:414-477-0513
Practice Address - Street 1:4645 S DELPHINE DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-6631
Practice Address - Country:US
Practice Address - Phone:414-477-0513
Practice Address - Fax:414-477-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty