Provider Demographics
NPI:1437593134
Name:BIESBROUCK, JEREMY A (BCBA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:BIESBROUCK
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-1623
Mailing Address - Country:US
Mailing Address - Phone:906-233-1322
Mailing Address - Fax:906-233-1220
Practice Address - Street 1:100 MALTON RD STE 7
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2002
Practice Address - Country:US
Practice Address - Phone:906-464-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)