Provider Demographics
NPI:1053897025
Name:JOHNSON-DUNLOP, BRITT (RBT-18-60264)
Entity type:Individual
Prefix:MS
First Name:BRITT
Middle Name:
Last Name:JOHNSON-DUNLOP
Suffix:
Gender:F
Credentials:RBT-18-60264
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3243
Mailing Address - Country:US
Mailing Address - Phone:630-621-2434
Mailing Address - Fax:
Practice Address - Street 1:820 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3243
Practice Address - Country:US
Practice Address - Phone:630-593-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-48928103K00000X
IL1-21-48928103K00000X
IL18-60264106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician