Provider Demographics
NPI:1760985451
Name:BLANTON, BRYANNE LEE (BCBA, LBA, MS)
Entity Type:Individual
Prefix:
First Name:BRYANNE
Middle Name:LEE
Last Name:BLANTON
Suffix:
Gender:F
Credentials:BCBA, LBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7421 LOST NATION RD
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-2639
Mailing Address - Country:US
Mailing Address - Phone:262-758-7192
Mailing Address - Fax:
Practice Address - Street 1:150 N SUNNY SLOPE RD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4806
Practice Address - Country:US
Practice Address - Phone:262-432-5660
Practice Address - Fax:262-432-5666
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1091-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst