Provider Demographics
NPI:1477063576
Name:BAER, BRITTANY MICHELLE WISE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MICHELLE WISE
Last Name:BAER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MICHELLE
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N MADISON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3301
Mailing Address - Country:US
Mailing Address - Phone:906-399-7616
Mailing Address - Fax:
Practice Address - Street 1:7360 N LINCOLN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1705
Practice Address - Country:US
Practice Address - Phone:855-855-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-27866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst