Provider Demographics
NPI:1376279273
Name:BAHTIRI, DAFINA
Entity Type:Individual
Prefix:
First Name:DAFINA
Middle Name:
Last Name:BAHTIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6408
Mailing Address - Country:US
Mailing Address - Phone:847-465-9556
Mailing Address - Fax:
Practice Address - Street 1:991 OAK CREEK DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6408
Practice Address - Country:US
Practice Address - Phone:312-882-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-23-68375103K00000X
ILRBT-22-208825106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician