Healthcare Provider Details

I. General information

NPI: 1902246317
Provider Name (Legal Business Name): KETTY ESTHER CRUZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTHER CRUZ

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FINCHLEY CT
SCHAUMBURG IL
60194
US

IV. Provider business mailing address

1901 FINCHLEY CT
SCHAUMBURG IL
60194-2218
US

V. Phone/Fax

Practice location:
  • Phone: 773-350-4686
  • Fax:
Mailing address:
  • Phone: 773-350-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-35099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: