Healthcare Provider Details

I. General information

NPI: 1336602192
Provider Name (Legal Business Name): NATASHA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD IL
62703-5771
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 217-525-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: