MEDICARE: BRADLEY G FRIESWYK BGF PERFORMANCE SYSTEMS

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

General Provider Information

NPI Number	:	1477852887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY G FRIESWYK BGF PERFORMANCE SYSTEMS

Provider Business Mailing Address
First Line	:	6430 N CENTRAL AVE STE 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-2955
Country	:	US
Telephone Number	:	773-539-7099
Fax Number	:	833-589-3765

Provider Business Practice Location Address
First Line	:	6430 N CENTRAL AVE STE 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-2955
Country	:	US
Telephone Number	:	773-539-7099
Fax Number	:	833-589-3765

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRADLEY G FRIESWYK
Credential	:	BCBA
Telephone Number	:	773-539-7099

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	05/03/2024

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