Healthcare Provider Details

I. General information

NPI: 1457957292
Provider Name (Legal Business Name): KYLE DRANCHAK BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W BRADLEY AVE
CHAMPAIGN IL
61821-1849
US

IV. Provider business mailing address

1827 E IRELAND RD
SOUTH BEND IN
46614-2845
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-7447
  • Fax: 317-802-7325
Mailing address:
  • Phone: 574-387-4313
  • Fax: 574-204-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: