Deborah A Vanderwall
Individual provider Active NPI Assistant Behavior Analyst · Ingleside, IL
NPI 1437645835 · NPPES record last updated Jul 9, 2018
Key facts
- NPI
- 1437645835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assistant Behavior Analyst 106E00000X
- Practice address
- 26211 W Boesch PL
Ingleside, IL 60041-9775 - Phone
- (847) 344-4606
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240308003399 | IL | Practitioner - Clinical Social Worker | 9032555362 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Center of Grayslake LTD. | Current |
Accepting new patients |
Locations
106 Center St
Grayslake, IL 60030
Phone (847) 543-8400
1190 E Washington St
Grayslake, IL 60030
Phone (847) 477-0434
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | Yes |
Addresses
Primary practice location
26211 W Boesch PL
Ingleside, IL 60041-9775
Mailing address
26211 W Boesch PL
Ingleside, IL 60041-9775
Phone (847) 344-4606
Other providers in Ingleside, IL
- Nader Sallam
- Margueret Anne Spear
- Nicole Storz
- Sunshine Pediatrics, S.C.
- Allison Szramek
- We Care for You Nursing Agency
- We Care for You Nursing Agency LLC
- Westlake Dental Center
- William C. Dam, M.D.S.C.
All providers in Ingleside, IL · Assistant 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 Jul 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.