Provider Demographics
NPI:1477150407
Name:VANNOSTRAND, MATTIE (BCBA)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:VANNOSTRAND
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MATTIE
Other - Middle Name:
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:950 LEE ST STE 12
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1638 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3602
Practice Address - Country:US
Practice Address - Phone:847-486-4140
Practice Address - Fax:847-486-4145
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-10-16
Deactivation Date:2021-07-01
Deactivation Code:
Reactivation Date:2021-08-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst