MEDICARE: BROWN BEAR EARLY INTERVENTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1043017700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN BEAR EARLY INTERVENTION LLC

Provider Business Mailing Address
First Line	:	1407 W 15TH ST APT 214
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2280
Country	:	US
Telephone Number	:	541-257-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 WINONA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1520
Country	:	US
Telephone Number	:	541-257-7028
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAMISH MOHAMMAD
Credential	:
Telephone Number	:	541-257-7028

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	02/28/2025

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