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NPI Code Detail

MEDICARE: CASSIDY ANCIRA

MEDICARE: CASSIDY ANCIRA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-22-60792IL

General Provider Information

NPI Number : 1972172526
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY ANCIRA
Provider Business Mailing Address
First Line : 4655 KIRCHOFF RD # 39
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-2070
Country : US
Telephone Number : 847-323-5536
Fax Number :
Provider Business Practice Location Address
First Line : 820 PARKVIEW BLVD
Second Line :
City : LOMBARD
State : IL
Zip : 60148-3200
Country : US
Telephone Number : 630-449-3101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2021
Last Update Date : 01/03/2024

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Directions to “ CASSIDY ANCIRA ” Practice Location

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