Healthcare Provider Details

I. General information

NPI: 1083229140
Provider Name (Legal Business Name): REBECCA A BREHM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 ENGEL DR
SHAWANO WI
54166-3746
US

IV. Provider business mailing address

1060 ENGEL DR
SHAWANO WI
54166-3746
US

V. Phone/Fax

Practice location:
  • Phone: 715-916-3889
  • Fax: 920-209-3166
Mailing address:
  • Phone: 715-916-3889
  • Fax: 920-209-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number385-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: