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General NPI Number Information
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NPI Number | 1558635318
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Entity Type | Individual
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Provider Name | DANIELLE L STAIR M.A. B.C.B.A.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2012
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Last Update Date | 02/26/2012
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Provider Practice Location Address
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Address Line | 4801 W PETERSON AVE SUITE 403
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City | CHICAGO
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State | IL
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Zip | 60646-5713
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Country | US
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Telephone | 773-407-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 3717 N FREMONT ST APT. 3S
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City | CHICAGO
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State | IL
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Zip | 60613-3911
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Country | US
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Telephone | 317-407-2984
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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 | 1-11-9280
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License Number State | IL
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