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General NPI Number Information
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NPI Number | 1154130425
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Entity Type | Individual
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Provider Name | TIMOTHY MISSELDINE
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Gender | Male
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 5167 W 111TH ST
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City | ALSIP
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State | IL
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Zip | 60803-6021
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Country | US
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Telephone | 773-524-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 916 193RD PL
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-7520
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Country | US
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Telephone | 563-419-7731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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