MEDICARE: ROBYN BLAYLOCK 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710529490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN BLAYLOCK BCBA

Provider Business Mailing Address
First Line	:	3417 N KENNICOTT AVE STE A
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7824
Country	:	US
Telephone Number	:	844-263-1613
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 N KENNICOTT AVE STE A
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7824
Country	:	US
Telephone Number	:	844-263-1613
Fax Number	:

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

Provider Enumeration Date	:	10/14/2019
Last Update Date	:	04/22/2025

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