Healthcare Provider Details

I. General information

NPI: 1801615281
Provider Name (Legal Business Name): KIMBERLY NICOLLE MURILLO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 TOWER CT STE A
GURNEE IL
60031-3318
US

IV. Provider business mailing address

1401 FUNDERBURK DR
WINTHROP HARBOR IL
60096-1868
US

V. Phone/Fax

Practice location:
  • Phone: 847-849-7498
  • Fax:
Mailing address:
  • Phone: 847-849-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.000523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: