MEDICARE: MS. CECILIA HIBBARD KNIGHT MA, 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	1-04-1867 (BCBA)	SC

General Provider Information

NPI Number	:	1659688505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CECILIA HIBBARD KNIGHT MA, BCBA

Provider Business Mailing Address
First Line	:	115 S MARION ST
Second Line	:	FIRST FLOOR
City	:	OAK PARK
State	:	IL
Zip	:	60302-2826
Country	:	US
Telephone Number	:	708-358-3000
Fax Number	:	708-524-0300

Provider Business Practice Location Address
First Line	:	115 S MARION ST
Second Line	:	FIRST FLOOR
City	:	OAK PARK
State	:	IL
Zip	:	60302-2826
Country	:	US
Telephone Number	:	708-358-3000
Fax Number	:	708-524-0300

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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