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NPI Code Detail

MEDICARE: DANA PAVLIK BCBA

MEDICARE: DANA PAVLIK 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
11041C0700XClinical Social Worker149.021478IL
2103K00000XBehavior Analyst11519395IL

General Provider Information

NPI Number : 1487910998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA PAVLIK BCBA
Provider Business Mailing Address
First Line : 429 W SURF ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6128
Country : US
Telephone Number : 773-852-5894
Fax Number :
Provider Business Practice Location Address
First Line : 3100 S CENTRAL AVE
Second Line :
City : CICERO
State : IL
Zip : 60804-3956
Country : US
Telephone Number : 708-863-3803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2012
Last Update Date : 05/17/2021

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Directions to “ DANA PAVLIK BCBA” Practice Location

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