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NPI Code Detail

MEDICARE: MR. NICHOLAS KYLE REETZ BCBA

MEDICARE: MR. NICHOLAS KYLE REETZ 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
1171M00000XCase Manager/Care Coordinator
2103K00000XBehavior Analyst
3103K00000XBehavior AnalystCOBA.00483OH
4103K00000XBehavior Analyst152.000310IL

General Provider Information

NPI Number : 1306233226
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS KYLE REETZ BCBA
Provider Business Mailing Address
First Line : 1622 S ALLPORT ST APT 1R
Second Line :
City : CHICAGO
State : IL
Zip : 60608-2187
Country : US
Telephone Number : 715-212-6103
Fax Number :
Provider Business Practice Location Address
First Line : 1233 W ADAMS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2801
Country : US
Telephone Number : 312-241-1204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2015
Last Update Date : 12/22/2025

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