Healthcare Provider Details

I. General information

NPI: 1205313814
Provider Name (Legal Business Name): BRENNA SATURDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 W MARKET ST
FAIRLAWN OH
44333-3339
US

IV. Provider business mailing address

3428 W MARKET ST
FAIRLAWN OH
44333-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4041
  • Fax:
Mailing address:
  • Phone: 330-668-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41121
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: