MEDICARE: CAITLIN TACADENA 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
2	103K00000X	Behavior Analyst	1-20-46516	IL

General Provider Information

NPI Number	:	1669842944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN TACADENA BCBA

Provider Business Mailing Address
First Line	:	587 WILSHIRE AVE
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-4975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 W HAWTHORN DR
Second Line	:
City	:	ITASCA
State	:	IL
Zip	:	60143-2056
Country	:	US
Telephone Number	:	800-844-1232
Fax Number	:

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

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	12/15/2020

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