Healthcare Provider Details

I. General information

NPI: 1679915524
Provider Name (Legal Business Name): BRIANNA ELSASSER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE STE 160
GRAND RAPIDS MI
49546-8313
US

IV. Provider business mailing address

2228 BRIDGEPORT RD NE APT 5
GRAND RAPIDS MI
49505-4053
US

V. Phone/Fax

Practice location:
  • Phone: 231-668-4909
  • Fax:
Mailing address:
  • Phone: 614-314-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: