Healthcare Provider Details

I. General information

NPI: 1972137610
Provider Name (Legal Business Name): MARY FRANCES FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5507 N CUMBERLAND AVE
CHICAGO IL
60656-4753
US

IV. Provider business mailing address

2040 W WABANSIA AVE APT 2
CHICAGO IL
60647-5691
US

V. Phone/Fax

Practice location:
  • Phone: 630-258-5928
  • Fax:
Mailing address:
  • Phone: 630-258-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001684
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.003447
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: