Healthcare Provider Details

I. General information

NPI: 1043144371
Provider Name (Legal Business Name): HOLLY BOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KENNEDY DR STE 80
BRADLEY IL
60915-2682
US

IV. Provider business mailing address

400 S KENNEDY DR STE 80
BRADLEY IL
60915-2682
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-4470
  • Fax:
Mailing address:
  • Phone: 815-939-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-544098
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: