NPI 1114482148 · live from the CMS NPI Registry
Ebony Augustin
Behavior Analyst in Crystal Lake, IL. National Provider Identifier 1114482148, active.
NPI record
| NPI | 1114482148 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 780 Mcardle Dr Ste Abc, Crystal Lake, IL 60014 |
| Practice phone | 779-220-6262 |
| Mailing address | 21600 Oxnard St Ste 1800, Woodland Hills, CA 91367 |
| Enumerated | February 4, 2019 |
| Last updated | February 4, 2019 |
| 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.