Provider Demographics
NPI:1114416831
Name:ZYBAK, AMY (RBT-18-48588)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ZYBAK
Suffix:
Gender:F
Credentials:RBT-18-48588
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20211 S JONQUIL LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8350
Mailing Address - Country:US
Mailing Address - Phone:815-274-4462
Mailing Address - Fax:
Practice Address - Street 1:20211 S JONQUIL LN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-8350
Practice Address - Country:US
Practice Address - Phone:815-274-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-48588106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician