Provider Demographics
NPI:1720546021
Name:BRENNAN, JONATHAN (BCBA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MARSH CIR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9268
Mailing Address - Country:US
Mailing Address - Phone:847-636-8894
Mailing Address - Fax:
Practice Address - Street 1:2519 CLAVER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4644
Practice Address - Country:US
Practice Address - Phone:833-455-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11832301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst