Provider Demographics
NPI:1679221634
Name:MCCONNELL, BRIDGET SULLIVAN (BCBA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:SULLIVAN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 RAVINE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7621
Mailing Address - Country:US
Mailing Address - Phone:224-485-1111
Mailing Address - Fax:
Practice Address - Street 1:2350 RAVINE WAY STE 100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7621
Practice Address - Country:US
Practice Address - Phone:224-485-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-76637103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst