MEDICARE: BRIDGET BORRELLI 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

General Provider Information

NPI Number	:	1528382454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET BORRELLI BCBA

Provider Business Mailing Address
First Line	:	15255 S 94TH AVE
Second Line	:	SUITE 500
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3800
Country	:	US
Telephone Number	:	312-342-0631
Fax Number	:	815-806-7439

Provider Business Practice Location Address
First Line	:	15255 S 94TH AVE
Second Line	:	SUITE 500
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-3800
Country	:	US
Telephone Number	:	312-342-0631
Fax Number	:	815-806-7439

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

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	06/14/2016

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