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NPI Code Detail

MEDICARE: AZADEH BASSIJ

MEDICARE: AZADEH BASSIJ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1598205098
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZADEH BASSIJ
Provider Business Mailing Address
First Line : 1056 BEDFORD DR
Second Line :
City : CAROL STREAM
State : IL
Zip : 60188-3920
Country : US
Telephone Number : 630-885-9222
Fax Number :
Provider Business Practice Location Address
First Line : 881 PARKVIEW BLVD
Second Line :
City : LOMBARD
State : IL
Zip : 60148-3230
Country : US
Telephone Number : 630-206-9252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2017
Last Update Date : 08/16/2024

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Directions to “ AZADEH BASSIJ ” Practice Location

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