NPI 1104194596 · live from the CMS NPI Registry
Equalla Agee
Behavior Analyst in Flossmoor, IL. National Provider Identifier 1104194596, active.
NPI record
| NPI | 1104194596 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 19530 Kedzie Ave, Flossmoor, IL 60422 |
| Practice phone | 708-754-8815 |
| Mailing address | 17746 Oak Park Ave, Tinley Park, IL 60477 |
| Enumerated | December 13, 2011 |
| Last updated | December 13, 2011 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.