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General NPI Number Information
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NPI Number | 1720687155
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Entity Type | Individual
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Provider Name | COURTNEY LYNN BRENDLE BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 2155 POINT BLVD
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City | ELGIN
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State | IL
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Zip | 60123-8800
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Country | US
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Telephone | 224-435-5632
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 SYCAMORE ST
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City | ELGIN
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State | IL
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Zip | 60123-4104
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Country | US
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Telephone | 847-714-3630
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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 | 1-20-45041
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License Number State | IL
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