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NPI Code Detail

MEDICARE: LOURDES RENDON MS, BCBA

MEDICARE: LOURDES RENDON MS, 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1487287421
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOURDES RENDON MS, BCBA
Provider Business Mailing Address
First Line : 538 N ASHBURY AVE
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-1202
Country : US
Telephone Number : 708-435-9885
Fax Number :
Provider Business Practice Location Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 11/03/2023

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