Bridge to Brilliance Therapy LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

BRIDGE TO BRILLIANCE THERAPY LLC

Practice address

13740 Nicollet Ave
Burnsville, MN 55337-4003

Phone

(612) 987-3455

NPI assigned

Oct 2, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anisa Mohamed Ahmed

Title

Owner

Phone

(612) 987-3455

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1114707700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7764 OAKRIDGE TRL",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553795509",
            "telephone_number": "612-987-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13740 NICOLLET AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374003",
            "telephone_number": "612-987-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE TO BRILLIANCE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-02",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "ANISA",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-987-3455"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093450918",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Ann Brennan, PSYD
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• Early Intervention Provider Agency in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.