Individual
DERRICK L VICTORIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
917 SHERWOOD DR, LAKE BLUFF, IL 60044-2224
(877) 486-4140
Mailing address
415 S LINCOLN AVE, WAUKEGAN, IL 60085-6345
(847) 445-5192
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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