Healthcare Provider Details

I. General information

NPI: 1740163294
Provider Name (Legal Business Name): EMILY GRACE BRANDT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E SAPP ST
WILCOX NE
68982-2502
US

IV. Provider business mailing address

1649 61ST ST
BROOKLYN NY
11204-2746
US

V. Phone/Fax

Practice location:
  • Phone: 308-830-0642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1389149
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: