Healthcare Provider Details

I. General information

NPI: 1598205098
Provider Name (Legal Business Name): AZADEH BASSIJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 08/16/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 PARKVIEW BLVD
LOMBARD IL
60148-3230
US

IV. Provider business mailing address

1056 BEDFORD DR
CAROL STREAM IL
60188-3920
US

V. Phone/Fax

Practice location:
  • Phone: 630-206-9252
  • Fax:
Mailing address:
  • Phone: 630-885-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: