Provider Demographics
NPI:1679016836
Name:BRONAUGH, ANTHONY THOMAS SR (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:THOMAS
Last Name:BRONAUGH
Suffix:SR
Gender:M
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MONROE ST STE 232
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3461
Mailing Address - Country:US
Mailing Address - Phone:419-574-9290
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:5151 MONROE ST STE 232
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3461
Practice Address - Country:US
Practice Address - Phone:419-574-9290
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-21-46996103K00000X
OH1-21-46996103K00000X
247200000X
OHCOBA.00851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other