Mallory Greenbank, BCBA
Individual provider Active NPI Behavior Analyst · La Grange, IL
NPI 1427620186 · NPPES record last updated Apr 27, 2022
Key facts
- NPI
- 1427620186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-22-57879 (IL)
- Practice address
- 18 N Catherine Ave
La Grange, IL 60525-5930 - Phone
- (708) 482-9453
- NPI assigned
- Jul 13, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-22-57879 | IL | Yes |
Addresses
Primary practice location
18 N Catherine Ave
La Grange, IL 60525-5930
Mailing address
18 N Catherine Ave
La Grange, IL 60525-5930
Phone (708) 482-9453
Other providers in La Grange, IL
- Danielle Marie Goduto
- Allison Gonzalez
- Gordon Fimreite, DC, S.C.
- Vladislav I Gorengaut
- Dominique Gousset
- Kimberly Allison Gregoriou
- William H Gros
- Tammy Michele Gross-McCoy
- Jennifer M Gula
- Deanne Marie Gustafson
All providers in La Grange, IL · Behavior Analyst in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.