MEDICARE: APRIL BOWGREN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-16-22009	IL

General Provider Information

NPI Number	:	1114389400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL BOWGREN BCBA

Provider Business Mailing Address
First Line	:	8609 W BRYN MAWR AVE STE 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3524
Country	:	US
Telephone Number	:	773-726-1416
Fax Number	:	224-241-3132

Provider Business Practice Location Address
First Line	:	3501 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3910
Country	:	US
Telephone Number	:	773-372-2492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	07/29/2021

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