Healthcare Provider Details

I. General information

NPI: 1437697083
Provider Name (Legal Business Name): NICOLE GRIFFIN LIPOWSKI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN NICOLE GRIFFIN BCBA

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8223 W 141ST ST
ORLAND PARK IL
60462-2323
US

IV. Provider business mailing address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

V. Phone/Fax

Practice location:
  • Phone: 912-690-5735
  • Fax:
Mailing address:
  • Phone: 773-644-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36585
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: