Healthcare Provider Details

I. General information

NPI: 1609356278
Provider Name (Legal Business Name): REMY COMERFORD KALEB BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA COMERFORD BCBA

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7029 N GREENVIEW AVE APT 2S
CHICAGO IL
60626-2856
US

IV. Provider business mailing address

7029 N GREENVIEW AVE APT 2S
CHICAGO IL
60626-2856
US

V. Phone/Fax

Practice location:
  • Phone: 309-530-1397
  • Fax:
Mailing address:
  • Phone: 309-530-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32573
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: