Healthcare Provider Details

I. General information

NPI: 1932603164
Provider Name (Legal Business Name): ANN BEDNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W ROOSEVELT RD STE 103
WEST CHICAGO IL
60185-4819
US

IV. Provider business mailing address

245 W ROOSEVELT RD STE 103
WEST CHICAGO IL
60185-4819
US

V. Phone/Fax

Practice location:
  • Phone: 312-882-5115
  • Fax:
Mailing address:
  • Phone: 312-882-5115
  • Fax: 630-429-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46237
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: