Healthcare Provider Details

I. General information

NPI: 1083236582
Provider Name (Legal Business Name): CHELSEA MEADOWS BCBA, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

IV. Provider business mailing address

1118 BALDWIN ST
MECHANICSBURG PA
17055-3934
US

V. Phone/Fax

Practice location:
  • Phone: 773-644-7787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBH003570
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26514
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: