MEDICARE: BRIANNA L COALE MS ED, 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
1	103K00000X	Behavior Analyst	2013017320	MO

General Provider Information

NPI Number	:	1255729703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA L COALE MS ED, BCBA, LBA

Provider Business Mailing Address
First Line	:	3051 E SWALLOW ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6658
Country	:	US
Telephone Number	:	417-599-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	3828 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5285
Country	:	US
Telephone Number	:	417-414-7353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	12/19/2022

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