Healthcare Provider Details

I. General information

NPI: 1700797818
Provider Name (Legal Business Name): HEATHER ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 REMINGTON RD
SCHAUMBURG IL
60173-4835
US

IV. Provider business mailing address

904 RIDGE SQ APT 310
ELK GROVE VILLAGE IL
60007-4122
US

V. Phone/Fax

Practice location:
  • Phone: 847-496-5513
  • Fax:
Mailing address:
  • Phone: 331-262-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1447378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: