Provider Demographics
NPI:1225920937
Name:HEATH, ELISHA (BCBA)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
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:N18242 MONSON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBINE
Mailing Address - State:WI
Mailing Address - Zip Code:54156-9312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 AMS CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-9704
Practice Address - Country:US
Practice Address - Phone:920-544-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1418-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst