Provider Demographics
NPI:1508154121
Name:BIANCHI-THOMASON, TRICIA M
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:M
Last Name:BIANCHI-THOMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SAINT JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-2948
Mailing Address - Country:US
Mailing Address - Phone:309-267-3771
Mailing Address - Fax:
Practice Address - Street 1:1315 SAINT JULIAN ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-2948
Practice Address - Country:US
Practice Address - Phone:309-267-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst