MEDICARE: EMMA ELIZABETH BRYERS BCBA

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	1-23-69723	IL

General Provider Information

NPI Number	:	1336915420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA ELIZABETH BRYERS BCBA

Provider Business Mailing Address
First Line	:	160 LEXINGTON DR STE B
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6929
Country	:	US
Telephone Number	:	847-224-3398
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 LEXINGTON DR STE B
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6929
Country	:	US
Telephone Number	:	847-224-3398
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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