MEDICARE: RAYESHUNDRA HENDERSON

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	106S00000X	Behavior Technician	RBT-18-63773	IL

General Provider Information

NPI Number	:	1205318680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYESHUNDRA HENDERSON

Provider Business Mailing Address
First Line	:	1220 WHISPERING HILLS CT APT 2B
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-4147
Country	:	US
Telephone Number	:	773-791-6845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 WHISPERING HILLS CT APT 2B
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-4147
Country	:	US
Telephone Number	:	773-791-6845
Fax Number	:

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

Provider Enumeration Date	:	09/03/2018
Last Update Date	:	09/03/2018

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