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General NPI Number Information
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NPI Number | 1659780740
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Entity Type | Individual
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Provider Name | BRIDGET THERESA FLEMING MSED, EDS, BCBA,CAGS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 315 S BASSWOOD RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2808
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Country | US
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Telephone | 781-608-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S BASSWOOD RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2808
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Country | US
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Telephone | 781-608-2906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-6847
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License Number State |
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