Healthcare Provider Details

I. General information

NPI: 1902399850
Provider Name (Legal Business Name): MICHELLE BREMNER BCBA 1-18-31595
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 04/17/2024
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E WILMETTE RD STE E
PALATINE IL
60074-6495
US

IV. Provider business mailing address

70 CEDAR RDG APT C
LAKE BARRINGTON IL
60010-6204
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-0955
  • Fax:
Mailing address:
  • Phone: 847-666-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31595
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-43470
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: