Provider Demographics
NPI:1407406432
Name:FOYDEL, WILLIAM HARRISON (RBT-19-97921)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRISON
Last Name:FOYDEL
Suffix:
Gender:M
Credentials:RBT-19-97921
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MAPLE AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4376
Mailing Address - Country:US
Mailing Address - Phone:847-309-2027
Mailing Address - Fax:
Practice Address - Street 1:1310 MAPLE AVE APT 4D
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4376
Practice Address - Country:US
Practice Address - Phone:847-309-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-97921106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician