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NPI Code Detail

MEDICARE: MS. ERICA DIANE DUIJZER BCBA

MEDICARE: MS. ERICA DIANE DUIJZER 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1780862458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERICA DIANE DUIJZER BCBA
Provider Business Mailing Address
First Line : 1451 W BELLE PLAINE AVE APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60613-7164
Country : US
Telephone Number : 815-674-6216
Fax Number :
Provider Business Practice Location Address
First Line : 5220 6TH STREET FRONTAGE RD E STE 1700
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5771
Country : US
Telephone Number : 773-415-5501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2008
Last Update Date : 09/23/2024

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