Individual
MR. KEVIN THENGUMOOTTIL MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
5059 W OAKDALE AVE, CHICAGO, IL 60641-5016
(773) 831-9950
Mailing address
5059 W OAKDALE AVE, CHICAGO, IL 60641-5016
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-68973
IL
Other
Enumeration date
11/08/2023
Last updated
11/14/2023
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