Healthcare Provider Details

I. General information

NPI: 1801618517
Provider Name (Legal Business Name): MEREDITH ANN NOLAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 S NEIL ST
CHAMPAIGN IL
61820-7272
US

IV. Provider business mailing address

2508 FIELDS SOUTH DR APT 305
CHAMPAIGN IL
61822-3718
US

V. Phone/Fax

Practice location:
  • Phone: 224-298-7462
  • Fax:
Mailing address:
  • Phone: 630-200-7043
  • 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: