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NPI Code Detail

MEDICARE: INDIVISUAL ABA

MEDICARE: INDIVISUAL ABA
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1194168823
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDIVISUAL ABA
Provider Business Mailing Address
First Line : 1984 SEDGEGRASS TRL
Second Line :
City : AURORA
State : IL
Zip : 60504-4329
Country : US
Telephone Number : 217-317-9688
Fax Number :
Provider Business Practice Location Address
First Line : 1984 SEDGEGRASS TRL
Second Line :
City : AURORA
State : IL
Zip : 60504-4329
Country : US
Telephone Number : 217-317-9688
Fax Number :
Authorized Official
Title or Position : BEHAVIOR SPECIALIST
Name : ANGELA DANIELS
Credential :
Telephone Number : 217-317-9688
Provider Enumeration Date : 04/11/2013
Last Update Date : 04/11/2013

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Directions to “INDIVISUAL ABA ” Practice Location

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