Provider Demographics
NPI:1023527405
Name:THEIL, EMILY ANN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:THEIL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:BROTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16930 ROBBINS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16930 ROBBINS RD STE 120
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2784
Practice Address - Country:US
Practice Address - Phone:616-935-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst