Basic Information
| Provider Information | |||||||||
| NPI: | 1649801143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECRAFT | ||||||||
| FirstName: | MANU | ||||||||
| MiddleName: | SOTEMANN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3113 W BELTLINE HWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088196810 | ||||||||
| FaxNumber: | 2242581400 | ||||||||
| Practice Location | |||||||||
| Address1: | 3113 W BELTLINE HWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088196810 | ||||||||
| FaxNumber: | 2242581400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 333-140 | WI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.