Individual
MCKENZIE THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
5221 6TH STREET FRONTAGE RD E STE 100, SPRINGFIELD, IL 62703-5745
(712) 305-5526
Mailing address
1604 TORONTO RD APT 10, SPRINGFIELD, IL 62712-3702
(712) 305-5266
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-70003
—
106S00000X
Behavior Technician
RBT-21-163887
VA
Other
Enumeration date
04/20/2021
Last updated
12/08/2023
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