Individual
MS. REBECCA ANN BLACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
14701 S LA GRANGE RD FL 2, ORLAND PARK, IL 60462-3226
(224) 470-0057
Mailing address
8609 W BRYN MAWR AVE STE 204, CHICAGO, IL 60631-3524
(773) 726-1416
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-08-4267
PA
Other
Enumeration date
03/27/2009
Last updated
09/03/2021
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