Provider Demographics
NPI:1588939300
Name:BROWN, MELISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:19060 EVERETT BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2500
Mailing Address - Country:US
Mailing Address - Phone:815-641-9187
Mailing Address - Fax:779-324-5236
Practice Address - Street 1:19060 EVERETT BLVD UNIT 107
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2500
Practice Address - Country:US
Practice Address - Phone:815-641-9187
Practice Address - Fax:779-324-5236
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1-11-8948103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst