MEDICARE: CONNIE BRUSHABER

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	:	1881927176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE BRUSHABER

Provider Business Mailing Address
First Line	:	706 GALLANT DR
Second Line	:
City	:	MINOOKA
State	:	IL
Zip	:	60447-8836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	SUITE #151
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-305-4196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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Directions to “ CONNIE BRUSHABER ” Practice Location

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