Individual
NICOLE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1315 MACOM DR STE LL-003, NAPERVILLE, IL 60564-9358
(630) 299-3325
Mailing address
1112 W BOUGHTON RD # 156, BOLINGBROOK, IL 60440-1508
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-32613
IL
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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