Healthcare Provider Details

I. General information

NPI: 1598346819
Provider Name (Legal Business Name): BRITNEY JASA HARTOG BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 OFFICE PKWY
CREVE COEUR MO
63141-7103
US

IV. Provider business mailing address

650 OFFICE PKWY
CREVE COEUR MO
63141-7103
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-1465
  • Fax:
Mailing address:
  • Phone: 314-838-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2022040348
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: