Provider Demographics
NPI:1821687443
Name:GLOSE, BONNIE LOUISE (MA, BCBA, LBSC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LOUISE
Last Name:GLOSE
Suffix:
Gender:F
Credentials:MA, BCBA, LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 W GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4059
Mailing Address - Country:US
Mailing Address - Phone:610-657-1488
Mailing Address - Fax:
Practice Address - Street 1:3865 ADLER PL
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9000
Practice Address - Country:US
Practice Address - Phone:610-867-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-04-2051103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst