Basic Information
| Provider Information | |||||||||
| NPI: | 1083277495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERBST | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 W OAKDALE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606415415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755607187 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1161 LAKE COOK RD | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600155649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474985437 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2019 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-18-33492 | IL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-18-33492 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.