Basic Information
| Provider Information | |||||||||
| NPI: | 1679016836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRONAUGH | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MED, BCBA, COBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 MONROE ST STE 232 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195749290 | ||||||||
| FaxNumber: | 2487124381 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 MONROE ST STE 232 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436233461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195749290 | ||||||||
| FaxNumber: | 2487124381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2016 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-46996 | MI | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-21-46996 | OH | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103K00000X | COBA.00851 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.