Jeremy Brog, RBT
Individual provider Active NPI Behavior Analyst · Olivette, MO
NPI 1356976922 · NPPES record last updated Mar 4, 2020
Key facts
- NPI
- 1356976922
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- RBT-19-104713 (MO)
- Practice address
- 9374 Olive Blvd Ste 101
Olivette, MO 63132-3253 - Phone
- (314) 932-2402
- NPI assigned
- Mar 4, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-104713 | MO | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | RBT-19-104713 | MO | Yes |
Addresses
Primary practice location
9374 Olive Blvd Ste 101
Olivette, MO 63132-3253
Mailing address
9374 Olive Blvd Ste 101
Olivette, MO 63132-3253
Other providers in Olivette, MO
- Bluesprig
- Harsha Bollepalli
- Lindy Michelle Boswell
- Roneeka Boyd
- Shelby Bridgers
- Michael D Brooks
- Alicia Christine Broshuis
- Maleah Brotherton
- Benjamin Robert Brown
- Adrianne Renee Bruckner
All providers in Olivette, MO · Behavior Analyst in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.