Healthcare Provider Details

I. General information

NPI: 1508448242
Provider Name (Legal Business Name): AMY VERNAGALLO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N WASHINGTON ST
NAPERVILLE IL
60540-4511
US

IV. Provider business mailing address

2227 WILDFLOWER CT
GENEVA IL
60134-4314
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-0506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1999358
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: