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General NPI Number Information
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NPI Number | 1699194373
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Entity Type | Individual
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Provider Name | LAURA BONFANTE MS, BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 3385 N ARLINGTON HEIGHTS RD SUITE K
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-7702
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Country | US
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Telephone | 844-247-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 3385 N ARLINGTON HEIGHTS RD SUITE K
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-7702
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Country | US
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Telephone | 844-247-7222
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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 | 1-12-11388
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License Number State | IL
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