Basic Information
| Provider Information | |||||||||
| NPI: | 1467103739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOPESKY | ||||||||
| FirstName: | MCKENNA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 N HOLLYWOOD WAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915055031 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 S SUNNY SLOPE RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530054857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442631613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2022 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 479-140 | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.