MEDICARE: KATRYNA DIANA MACLEAN RBT

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		IL

General Provider Information

NPI Number	:	1790636231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRYNA DIANA MACLEAN RBT

Provider Business Mailing Address
First Line	:	5830 SUNSET AVE
Second Line	:
City	:	LA GRANGE HIGHLANDS
State	:	IL
Zip	:	60525-7119
Country	:	US
Telephone Number	:	708-247-1984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 MOON LAKE BLVD STE AND140
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1069
Country	:	US
Telephone Number	:	708-927-4127
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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