Healthcare Provider Details

I. General information

NPI: 1790607760
Provider Name (Legal Business Name): WHITEFORD BEHAVIOR CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 CHICKASAW DR
CARBONDALE IL
62902-0535
US

IV. Provider business mailing address

5175 CHICKASAW DR
CARBONDALE IL
62902-0535
US

V. Phone/Fax

Practice location:
  • Phone: 847-370-9031
  • Fax:
Mailing address:
  • Phone: 847-370-9031
  • 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: KRISTEN WHITEFORD
Title or Position: MANAGING MEMBER
Credential: MS, LBA, BCBA
Phone: 847-370-9031