MEDICARE: MS. NIJAH ARANDA

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	1-16-24662	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	853344992	OTHER	IL	GROUP TAX ID

General Provider Information

NPI Number	:	1871203174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIJAH ARANDA

Provider Business Mailing Address
First Line	:	3336 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3327
Country	:	US
Telephone Number	:	773-456-8217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W GRAND AVE STE B17739
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	312-448-7310
Fax Number	:

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

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	11/29/2022

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