MEDICARE: MRS. ELIZABETH WARREN 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

General Provider Information

NPI Number	:	1730787532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH WARREN BCBA

Provider Business Mailing Address
First Line	:	1274 STAR GRASS LN
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-6524
Country	:	US
Telephone Number	:	260-246-2980
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	:	815-468-1500
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	09/02/2022

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