Individual
MR. NICHOLAS ALBERT MACAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 VETERANS PKWY, NEW LENOX, IL 60451-2899
(815) 717-1700
Mailing address
301 VETERANS PKWY, NEW LENOX, IL 60451-2899
(815) 717-1700
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8422752
—
IL
Enumeration date
12/07/2016
Last updated
12/07/2016
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