Provider Demographics
NPI:1093335077
Name:KING, MARCIA LAWRENCE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LAWRENCE
Last Name:KING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6033 N SHERIDAN RD APT 19M
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3026
Mailing Address - Country:US
Mailing Address - Phone:847-975-0433
Mailing Address - Fax:
Practice Address - Street 1:5000 OAKTON ST APT 308
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2979
Practice Address - Country:US
Practice Address - Phone:847-975-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
225XP0200X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics