Healthcare Provider Details

I. General information

NPI: 1013841725
Provider Name (Legal Business Name): AUTUMN CHMIELEWSKI MAT, MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E DARTMOOR DR
CRYSTAL LAKE IL
60014-8710
US

IV. Provider business mailing address

38W505 MALLARD LAKE RD
SAINT CHARLES IL
60175-6825
US

V. Phone/Fax

Practice location:
  • Phone: 888-308-3728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-447160
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1190712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: