Basic Information
| Provider Information | |||||||||
| NPI: | 1932477577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFER | ||||||||
| FirstName: | CHRISTIANA | ||||||||
| MiddleName: | KIMBERLY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774874141 | ||||||||
| FaxNumber: | 8474864145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 WAUKEGAN RD | ||||||||
| Address2: | 103 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600253070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774874141 | ||||||||
| FaxNumber: | 8474864145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2011 | ||||||||
| LastUpdateDate: | 12/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-11-8666 | CT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.