Healthcare Provider Details

I. General information

NPI: 1184126823
Provider Name (Legal Business Name): CELESTE BUDZYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CELESTE PLAUTZ BCBA 1-19-36720

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 04/28/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

IV. Provider business mailing address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

V. Phone/Fax

Practice location:
  • Phone: 847-247-7222
  • Fax:
Mailing address:
  • Phone: 847-807-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number15-10392
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36720
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: