Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003383845 |
---|---|
Provider Name | Amanda Chastain |
First Address | Chicago, IL 60608-1316 |
Second Address | Chicago, IL 60608-1316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 25/08/2021 |