Individual
MS. MACKENZIE LAESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
301 S PROSPECT RD STE 2, BLOOMINGTON, IL 61704-4908
(224) 436-0788
Mailing address
8609 W BRYN MAWR AVE STE 204, CHICAGO, IL 60631-3524
(773) 726-1416
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27610
IL
Other
Enumeration date
04/06/2018
Last updated
12/03/2021
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