Provider Demographics
NPI:1659780740
Name:FLEMING, BRIDGET THERESA (MSED, EDS, BCBA,CAGS)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:THERESA
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MSED, EDS, BCBA,CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2808
Mailing Address - Country:US
Mailing Address - Phone:781-608-2906
Mailing Address - Fax:
Practice Address - Street 1:315 S BASSWOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2808
Practice Address - Country:US
Practice Address - Phone:781-608-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-6847103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst