Healthcare Provider Details

I. General information

NPI: 1346026424
Provider Name (Legal Business Name): BROOKE YEAGER M.ED., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 W MONTROSE AVE
CHICAGO IL
60613-1348
US

IV. Provider business mailing address

10 W CHESTNUT ST APT 1
CHICAGO IL
60610-3362
US

V. Phone/Fax

Practice location:
  • Phone: 773-944-0864
  • Fax:
Mailing address:
  • Phone: 513-859-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: