Healthcare Provider Details

I. General information

NPI: 1073098182
Provider Name (Legal Business Name): COURTNEY RENEE PENNING BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38555 MOUND RD STE 100
STERLING HEIGHTS MI
48310-3206
US

IV. Provider business mailing address

1112 WAYCROFT CT
ROCHESTER MI
48307-6043
US

V. Phone/Fax

Practice location:
  • Phone: 586-232-1040
  • Fax:
Mailing address:
  • Phone: 489-784-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46175
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-65489
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: