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General NPI Number Information
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NPI Number | 1558209247
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Entity Type | Individual
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Provider Name | AYVA TUPACEV
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Gender | Female
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 3351 HOBSON RD STE B
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City | WOODRIDGE
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State | IL
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Zip | 60517-1689
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Country | US
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Telephone | 866-673-5278
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Fax |
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Provider Business Mailing Address
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Address Line | 8539 SANDALWOOD DR
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City | DARIEN
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State | IL
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Zip | 60561-1706
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Country | US
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Telephone | 630-974-7776
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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 | IL
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