Healthcare Provider Details

I. General information

NPI: 1114428885
Provider Name (Legal Business Name): AERIELLE BRIANNA HEGR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA HEGR

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N FRESNO ST STE 106
FRESNO CA
93710-6849
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48589
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: