Healthcare Provider Details

I. General information

NPI: 1356073399
Provider Name (Legal Business Name): ZACHARY BRYCE STANSBERRY BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 NATIONAL PKWY STE 60
SCHAUMBURG IL
60173-5160
US

IV. Provider business mailing address

2033 N WESTERN AVE APT 3F
CHICAGO IL
60647-4380
US

V. Phone/Fax

Practice location:
  • Phone: 224-548-8813
  • Fax:
Mailing address:
  • Phone: 804-274-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.001383
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: