Provider Demographics
NPI:1174090484
Name:CALDWELL-CHADWICK, ROGER KYLE (MS, BCBA, LBA, CSAC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:KYLE
Last Name:CALDWELL-CHADWICK
Suffix:
Gender:M
Credentials:MS, BCBA, LBA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N OLD WORLD 3RD ST APT 1103
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2242
Mailing Address - Country:US
Mailing Address - Phone:414-902-3932
Mailing Address - Fax:
Practice Address - Street 1:11121 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-4033
Practice Address - Country:US
Practice Address - Phone:262-641-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253-140103K00000X
WI17123-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst