MEDICARE: KAITLIN LOUISA MCNEILL M.ADS, 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

General Provider Information

NPI Number	:	1457812141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN LOUISA MCNEILL M.ADS, BCBA

Provider Business Mailing Address
First Line	:	435 W OAKDALE AVE APT 4C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5950
Country	:	US
Telephone Number	:	773-505-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 W WILLOW ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-8977
Country	:	US
Telephone Number	:	312-399-0370
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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