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General NPI Number Information
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NPI Number | 1194168823
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Entity Type | Organization
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Legal Business Name | INDIVISUAL ABA
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1984 SEDGEGRASS TRL
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City | AURORA
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State | IL
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Zip | 60504-4329
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Country | US
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Telephone | 217-317-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 1984 SEDGEGRASS TRL
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City | AURORA
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State | IL
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Zip | 60504-4329
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Country | US
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Telephone | 217-317-9688
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR SPECIALIST
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Name | ANGELA DANIELS
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Credential |
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Telephone | 217-317-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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