MEDICARE: CHRISTIN WHITT-SOLECKI 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	1-19-39928	IL

General Provider Information

NPI Number	:	1568984599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIN WHITT-SOLECKI BCBA

Provider Business Mailing Address
First Line	:	1211 FARMINGTON LAKES DR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-5109
Country	:	US
Telephone Number	:	815-469-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 FARMINGTON LAKES DR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-5109
Country	:	US
Telephone Number	:	815-469-1500
Fax Number	:

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

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	03/16/2022

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