Healthcare Provider Details

I. General information

NPI: 1720957822
Provider Name (Legal Business Name): GRAHAM HEBISEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S MORGAN ST SUITE C101
PILSEN IL
63088-2500
US

IV. Provider business mailing address

504 N GREEN ST UNIT 1301
CHICAGO IL
60642-6529
US

V. Phone/Fax

Practice location:
  • Phone: 224-404-2994
  • Fax:
Mailing address:
  • Phone: 636-399-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2024019787
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.003412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: