MEDICARE: STEPHANIE TCHOP RBT-18-61264

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	106S00000X	Behavior Technician	18-61264	IL

General Provider Information

NPI Number	:	1669959490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE TCHOP RBT-18-61264

Provider Business Mailing Address
First Line	:	413 SIDNEY AVE UNIT A
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3149
Country	:	US
Telephone Number	:	618-535-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 SIDNEY AVE UNIT A
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3149
Country	:	US
Telephone Number	:	618-535-4905
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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