Healthcare Provider Details

I. General information

NPI: 1952811903
Provider Name (Legal Business Name): NATALIJA VAZNELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16W361 S FRONTAGE RD STE 131
BURR RIDGE IL
60527-5816
US

IV. Provider business mailing address

13507 S RED COAT DR
LEMONT IL
60439-8160
US

V. Phone/Fax

Practice location:
  • Phone: 630-590-5571
  • Fax:
Mailing address:
  • Phone: 630-303-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: