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General NPI Number Information
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NPI Number | 1548114564
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Entity Type | Organization
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Legal Business Name | MASON INTERVENTION, INC.
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 1213 WILMETTE AVE STE 207
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City | WILMETTE
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State | IL
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Zip | 60091-2566
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Country | US
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Telephone | 847-271-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 WILMETTE AVE STE 207
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City | WILMETTE
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State | IL
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Zip | 60091-2566
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Country | US
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Telephone | 847-271-6840
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Fax |
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Authorized Official
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Title or Position | OWNER & DIRECTOR
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Name | GWEN FISKE
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Credential | PH.D.
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Telephone | 847-271-6840
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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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