Healthcare Provider Details

I. General information

NPI: 1720730294
Provider Name (Legal Business Name): KASSIDY R VALENTIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E ARMSTRONG AVE
PEORIA IL
61603-3201
US

IV. Provider business mailing address

101 W CYPRESS ST
NORMAL IL
61761-1622
US

V. Phone/Fax

Practice location:
  • Phone: 309-686-1177
  • Fax: 309-686-7755
Mailing address:
  • Phone: 407-280-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86236
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: