MEDICARE: ASHLEY MACHANICKAL

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548803042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MACHANICKAL

Provider Business Mailing Address
First Line	:	1201 W GLENN LN
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 W GLENN LN
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4014
Country	:	US
Telephone Number	:	847-306-9843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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Directions to “ ASHLEY MACHANICKAL ” Practice Location

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