MEDICARE: BRANDI BROWN 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	0133000842	VA
2	103K00000X	Behavior Analyst	11520828	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649637364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI BROWN BCBA

Provider Business Mailing Address
First Line	:	7719 SARATOGA RIDGE CT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22153-2957
Country	:	US
Telephone Number	:	708-625-6134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 S LEXINGTON DR
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-5899
Country	:	US
Telephone Number	:	708-725-6134
Fax Number	:

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

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	03/03/2022

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Directions to “ BRANDI BROWN BCBA” Practice Location

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