Healthcare Provider Details

I. General information

NPI: 1639470263
Provider Name (Legal Business Name): HEATHER M DICKINSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 SEQUOIA CT
ORLAND PARK IL
60462-4239
US

IV. Provider business mailing address

5141 134TH PL
CRESTWOOD IL
60418-1480
US

V. Phone/Fax

Practice location:
  • Phone: 708-715-4656
  • Fax:
Mailing address:
  • Phone: 708-822-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: