1659688505 NPI number — MS. CECILIA HIBBARD KNIGHT MA, BCBA

Table of content: MS. CECILIA HIBBARD KNIGHT MA, BCBA (NPI 1659688505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659688505 NPI number — MS. CECILIA HIBBARD KNIGHT MA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT
Provider First Name:
CECILIA
Provider Middle Name:
HIBBARD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, 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:
1659688505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 S MARION ST
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-358-3000
Provider Business Mailing Address Fax Number:
708-524-0300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 S MARION ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-358-3000
Provider Business Practice Location Address Fax Number:
708-524-0300
Provider Enumeration Date:
09/13/2010

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:  1-04-1867 (BCBA) , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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