MEDICARE: CASSANDRA HALBERT

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	1-20-42422	IL

General Provider Information

NPI Number	:	1902424369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA HALBERT

Provider Business Mailing Address
First Line	:	604 W SURF ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 W WILLOW ST STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-8977
Country	:	US
Telephone Number	:	773-630-4400
Fax Number	:

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

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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Directions to “ CASSANDRA HALBERT ” Practice Location

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