Individual
MISS SHELBY CORINNE VANDEVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED, BCBA
Contact information
Practice address
411 E GENEVA RD, CAROL STREAM, IL 60188-2457
(815) 469-1500
Mailing address
4315 AZALEA DR APT 315, LISLE, IL 60532-1182
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-32221
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497240857
BCBA
IL
Enumeration date
06/28/2018
Last updated
10/04/2024
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