Healthcare Provider Details

I. General information

NPI: 1588137624
Provider Name (Legal Business Name): KIMBERLY WENDLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 10/17/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 W ALDER DR
HOFFMAN ESTATES IL
60192-1507
US

IV. Provider business mailing address

PO BOX 1457
SAINT CHARLES IL
60174-7420
US

V. Phone/Fax

Practice location:
  • Phone: 309-235-2947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB368054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: