Healthcare Provider Details

I. General information

NPI: 1477130714
Provider Name (Legal Business Name): FELICIA DAVID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14421 S WALLIN DR
PLAINFIELD IL
60544-2502
US

IV. Provider business mailing address

14100 SHEFFIELD DR APT 304
HOMER GLEN IL
60491-7907
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-6354
  • Fax:
Mailing address:
  • Phone: 708-224-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70034
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-24138
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: