Healthcare Provider Details

I. General information

NPI: 1073017398
Provider Name (Legal Business Name): CYNTHIA BARDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E LOOP RD
WHEATON IL
60189-8407
US

IV. Provider business mailing address

847 STAGHORN LN APT 102
NORTH AURORA IL
60542-1424
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-8487
  • Fax:
Mailing address:
  • Phone: 815-990-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-46043
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: