Provider Demographics
NPI:1245469725
Name:RICHARDSON, JEAN R (BCBA)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E SAYLES DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7145
Mailing Address - Country:US
Mailing Address - Phone:847-202-7051
Mailing Address - Fax:847-202-7051
Practice Address - Street 1:907 E SAYLES DR
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-7145
Practice Address - Country:US
Practice Address - Phone:847-202-7051
Practice Address - Fax:847-202-7051
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264621631OtherTRICARE