Healthcare Provider Details

I. General information

NPI: 1750819520
Provider Name (Legal Business Name): PRISCILLA BAER SCHIMKUS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 EBER BLVD STE 108
MELBOURNE FL
32904-8768
US

IV. Provider business mailing address

24 E AVENUE C
MELBOURNE FL
32901-1334
US

V. Phone/Fax

Practice location:
  • Phone: 321-536-3532
  • Fax:
Mailing address:
  • Phone: 321-427-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-40532
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-16-7511
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: