Individual
HEAVENLY BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 CRYSTAL LAKE RD, LAKE IN THE HILLS, IL 60156-1206
(773) 644-7787
Mailing address
8609 W BRYN MAWR AVE STE 204, CHICAGO, IL 60631-3524
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IL
Other
Enumeration date
11/02/2024
Last updated
11/02/2024
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