MEDICARE: KAYLA MACCANNON

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		IL

General Provider Information

NPI Number	:	1306770888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MACCANNON

Provider Business Mailing Address
First Line	:	PO BOX 564
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-0564
Country	:	US
Telephone Number	:	847-604-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-0149
Country	:	US
Telephone Number	:	847-604-0955
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ KAYLA MACCANNON ” Practice Location

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