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NPI Code Detail

MEDICARE: ELIZABETH ANNE GRESSARD MA, BCBA, LBA

MEDICARE: ELIZABETH ANNE GRESSARD MA, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystBEH-000839AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-22-58378OTHERBCBA CERTIFICATE

General Provider Information

NPI Number : 1245884964
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANNE GRESSARD MA, BCBA, LBA
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 1519 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85296-4793
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 02/04/2026

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