Healthcare Provider Details

I. General information

NPI: 1306233226
Provider Name (Legal Business Name): NICHOLAS KYLE REETZ BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US

IV. Provider business mailing address

2400 N SHEFFIELD AVE
CHICAGO IL
60614-3936
US

V. Phone/Fax

Practice location:
  • Phone: 773-389-2202
  • Fax: 773-688-3547
Mailing address:
  • Phone: 773-389-2202
  • Fax: 773-688-3547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.000310
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.00483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: