Healthcare Provider Details

I. General information

NPI: 1851165534
Provider Name (Legal Business Name): GABRIELLE GRACE DREW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US

IV. Provider business mailing address

437 W DIVISION ST APT 317
CHICAGO IL
60610-1720
US

V. Phone/Fax

Practice location:
  • Phone: 773-389-2202
  • Fax:
Mailing address:
  • Phone: 708-928-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152000750
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: