Provider Demographics
NPI:1417462045
Name:LAFLAIR, CORY KINSMAN (BCBA)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:KINSMAN
Last Name:LAFLAIR
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:KINSMAN
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 W SURF ST APT 219
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6039
Mailing Address - Country:US
Mailing Address - Phone:313-327-5484
Mailing Address - Fax:
Practice Address - Street 1:4433 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1820
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst