Individual
MALLORY GREENBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
18 N CATHERINE AVE, LA GRANGE, IL 60525-5930
(708) 482-9453
Mailing address
18 N CATHERINE AVE, LA GRANGE, IL 60525-5930
(708) 482-9453
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-57879
IL
Other
Enumeration date
07/13/2021
Last updated
04/27/2022
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