Provider Demographics
NPI:1356865075
Name:RUPP, CYNTHIA LESLIE (BCBA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LESLIE
Last Name:RUPP
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 1:1112 S WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7960
Mailing Address - Country:US
Mailing Address - Phone:331-826-0226
Mailing Address - Fax:
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:331-826-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor