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General NPI Number Information
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NPI Number | 1902399850
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Entity Type | Individual
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Provider Name | MICHELLE BREMNER BCBA 1-18-31595
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 887 E WILMETTE RD STE E
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City | PALATINE
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State | IL
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Zip | 60074-6495
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Country | US
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Telephone | 847-604-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 70 CEDAR RDG APT C
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City | LAKE BARRINGTON
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State | IL
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Zip | 60010-6204
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Country | US
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Telephone | 847-666-8750
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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 | 1-18-31595
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 17-43470
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-31595
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License Number State | IL
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