1326204090 NPI number — MISS HOLLY MARIE STUBNAR M.S,, BCBA

Table of content: MISS HOLLY MARIE STUBNAR M.S,, BCBA (NPI 1326204090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326204090 NPI number — MISS HOLLY MARIE STUBNAR M.S,, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUBNAR
Provider First Name:
HOLLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S,, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326204090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 W WRIGHTWOOD AVE
Provider Second Line Business Mailing Address:
913
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-1882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-201-1146
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 W WRIGHTWOOD AVE
Provider Second Line Business Practice Location Address:
913
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-201-1146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-07-3682 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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