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General NPI Number Information
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NPI Number | 1508655879
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Entity Type | Individual
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Provider Name | SIOBHAN HERREBOUT
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Gender |
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Dates
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Enumeration Date | 05/03/2025
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 2901 FINLEY RD STE 102
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1774
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Country | US
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Telephone | 630-495-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 14421 RIDGE AVE
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City | ORLAND PARK
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State | IL
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Zip | 60462-1961
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Country | US
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Telephone | 708-745-0954
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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-24-372715
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License Number State | IL
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