Provider Demographics
NPI:1114572575
Name:BERTAGNOLLI DUNN, ABBY LAUREN (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LAUREN
Last Name:BERTAGNOLLI DUNN
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:MRS
Other - First Name:ABBY
Other - Middle Name:LAUREN
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M ED, BCBA, LBA
Mailing Address - Street 1:2543 ROSS CLARK CIR STE 5
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4916
Mailing Address - Country:US
Mailing Address - Phone:334-618-4412
Mailing Address - Fax:334-699-4014
Practice Address - Street 1:751 RHODEN COVE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1013
Practice Address - Country:US
Practice Address - Phone:850-815-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12157187103K00000X
AL2022004103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst