Provider Demographics
NPI:1467817155
Name:O'SULLIVAN, JILLIAN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:
Last Name:O'SULLIVAN
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 1:16471 CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4341
Mailing Address - Country:US
Mailing Address - Phone:260-444-9215
Mailing Address - Fax:
Practice Address - Street 1:6775 PROSPERI DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4789
Practice Address - Country:US
Practice Address - Phone:708-429-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst