Provider Demographics
NPI:1902399850
Name:BREMNER, MICHELLE (BCBA 1-18-31595)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BREMNER
Suffix:
Gender:F
Credentials:BCBA 1-18-31595
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 CEDAR RDG APT C
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6204
Mailing Address - Country:US
Mailing Address - Phone:847-666-8750
Mailing Address - Fax:
Practice Address - Street 1:887 E WILMETTE RD STE E
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6495
Practice Address - Country:US
Practice Address - Phone:847-604-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31595103K00000X
IL17-43470106S00000X
IL1-18-31595103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician