Provider Demographics
NPI:1255676532
Name:SKINNER, CHELSEA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N LARRABEE ST APT 6301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4422
Mailing Address - Country:US
Mailing Address - Phone:269-377-9796
Mailing Address - Fax:
Practice Address - Street 1:1501 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4649
Practice Address - Country:US
Practice Address - Phone:269-377-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-12-12699103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-12--12699OtherBEHAVIOR ANALYST CERTIFICATION BOARD