Healthcare Provider Details

I. General information

NPI: 1750755807
Provider Name (Legal Business Name): KATIE TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2015
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 BARRINGTON DR
AURORA IL
60503-6276
US

IV. Provider business mailing address

537 CYPRESS DR
NAPERVILLE IL
60540-7204
US

V. Phone/Fax

Practice location:
  • Phone: 630-636-3519
  • Fax:
Mailing address:
  • Phone: 630-809-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152001416
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: