Healthcare Provider Details

I. General information

NPI: 1962331728
Provider Name (Legal Business Name): TERRIANNA CAROLYN GIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 SULLIVAN LN
UNIVERSITY PARK IL
60484-3031
US

IV. Provider business mailing address

658 SULLIVAN LN
UNIVERSITY PARK IL
60484-3031
US

V. Phone/Fax

Practice location:
  • Phone: 708-762-2907
  • Fax:
Mailing address:
  • Phone: 708-534-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: