Healthcare Provider Details

I. General information

NPI: 1578036703
Provider Name (Legal Business Name): CHRISTINA MARIE LONOSKY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 RIVER DR STE 101
MORTON GROVE IL
60053-2645
US

IV. Provider business mailing address

9199 NORTH RD APT C
PALOS HILLS IL
60465-2117
US

V. Phone/Fax

Practice location:
  • Phone: 224-470-1111
  • Fax:
Mailing address:
  • Phone: 708-733-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77081
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-5361-124737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: