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NPI Code Detail

MEDICARE: MS. AILEEN MARY HENNEBERRY BCBA

MEDICARE:  MS. AILEEN MARY HENNEBERRY  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 Analyst

General Provider Information

NPI Number : 1518442631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AILEEN MARY HENNEBERRY BCBA
Provider Business Mailing Address
First Line : 8200 185TH ST STE AB
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-9232
Country : US
Telephone Number : 708-580-0440
Fax Number :
Provider Business Practice Location Address
First Line : 8200 185TH ST STE AB
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-9232
Country : US
Telephone Number : 708-580-0440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2018
Last Update Date : 09/25/2018

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Directions to “ MS. AILEEN MARY HENNEBERRY BCBA” Practice Location

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