Provider Demographics
NPI:1073099644
Name:PIEKNIK, SYDNEY (BCBA)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PIEKNIK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W GRAND AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1025
Mailing Address - Country:US
Mailing Address - Phone:844-263-1613
Mailing Address - Fax:844-263-1612
Practice Address - Street 1:342 N WATER ST STE 600
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5715
Practice Address - Country:US
Practice Address - Phone:844-263-1613
Practice Address - Fax:844-263-1612
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI245-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst