Provider Demographics
NPI:1083229140
Name:BREHM, REBECCA A (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BREHM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-9720
Mailing Address - Country:US
Mailing Address - Phone:920-202-6318
Mailing Address - Fax:
Practice Address - Street 1:205 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9720
Practice Address - Country:US
Practice Address - Phone:920-202-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI385-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst