Healthcare Provider Details

I. General information

NPI: 1942454681
Provider Name (Legal Business Name): JOHN PINGO BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 N ROCKTON AVE
ROCKFORD IL
61103-1526
US

IV. Provider business mailing address

4596 SADDLE ST
LOVES PARK IL
61111-5335
US

V. Phone/Fax

Practice location:
  • Phone: 815-395-6070
  • Fax: 815-219-4030
Mailing address:
  • Phone: 815-985-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: