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General NPI Number Information
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NPI Number | 1487266805
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Entity Type | Individual
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Provider Name | MEGAN C GILDERSLEEVE BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 1136 S DELANO CT W STE B201
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City | CHICAGO
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State | IL
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Zip | 60605-3734
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Country | US
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Telephone | 219-921-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 5451 BUCKEYE AVE
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City | PORTAGE
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State | IN
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Zip | 46368-4205
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Country | US
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Telephone | 219-921-5747
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-16-20966
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-58165
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License Number State |
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