Healthcare Provider Details

I. General information

NPI: 1780173062
Provider Name (Legal Business Name): KAJAL DURIC BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 FARGO BLVD
GENEVA IL
60134-7504
US

IV. Provider business mailing address

2323 FARGO BLVD
GENEVA IL
60134-7504
US

V. Phone/Fax

Practice location:
  • Phone: 331-205-9460
  • Fax:
Mailing address:
  • Phone: 331-205-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: