Wala Mustafa
Individual provider Active NPI Behavior Technician · Worth, IL
NPI 1821893769 · NPPES record last updated Sep 22, 2025
Key facts
- NPI
- 1821893769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-25-412408 (IL)
- Practice address
- 11301 S. Harlem Ave
Worth, IL 60482 - Phone
- (708) 586-2604
- NPI assigned
- Feb 14, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-25-412408 | IL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Asd Life Inc. | Current |
Accepting new patients |
Locations
11301 S Harlem Ave
Worth, IL 60482
Phone (708) 305-3697
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-25-412408 | IL | Yes |
Addresses
Primary practice location
11301 S. Harlem Ave
Worth, IL 60482
Mailing address
7910 W 108TH St
Palos Hills, IL 60465-2340
Phone (708) 265-1065
Other providers in Worth, IL
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All providers in Worth, IL · Behavior Technician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2025. 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.