Provider Demographics
NPI:1417523440
Name:CHRISTENSEN, VICTORIA (BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHRISTENSEN
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 1:13368 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1426
Mailing Address - Country:US
Mailing Address - Phone:708-305-3697
Mailing Address - Fax:
Practice Address - Street 1:11301 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2001
Practice Address - Country:US
Practice Address - Phone:708-305-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-1833695103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst