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NPI Code Detail

MEDICARE: MISS SHELBY CORINNE VANDEVER M.ED, BCBA

MEDICARE: MISS SHELBY CORINNE VANDEVER M.ED, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-18-32221IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11497240857OTHERILBCBA

General Provider Information

NPI Number : 1497240857
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SHELBY CORINNE VANDEVER M.ED, BCBA
Provider Business Mailing Address
First Line : 4315 AZALEA DR APT 315
Second Line :
City : LISLE
State : IL
Zip : 60532-1182
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 411 E GENEVA RD
Second Line :
City : CAROL STREAM
State : IL
Zip : 60188-2457
Country : US
Telephone Number : 815-469-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2018
Last Update Date : 10/04/2024

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