Provider Demographics
NPI:1184242216
Name:O'GRADY, BRITTANY (BCBA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3424
Mailing Address - Country:US
Mailing Address - Phone:574-387-4313
Mailing Address - Fax:
Practice Address - Street 1:2314 HELEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1684
Practice Address - Country:US
Practice Address - Phone:269-359-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst