Provider Demographics
NPI:1326204090
Name:STUBNAR, HOLLY MARIE (MS,, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:MARIE
Last Name:STUBNAR
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 1:451 W WRIGHTWOOD AVE
Mailing Address - Street 2:913
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1882
Mailing Address - Country:US
Mailing Address - Phone:618-201-1146
Mailing Address - Fax:
Practice Address - Street 1:451 W WRIGHTWOOD AVE
Practice Address - Street 2:913
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1882
Practice Address - Country:US
Practice Address - Phone:618-201-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-07-3682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst