Provider Demographics
NPI:1518139658
Name:HOLLEDERER, JILL MARIE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:HOLLEDERER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DUNDEE RD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2437
Mailing Address - Country:US
Mailing Address - Phone:224-326-2203
Mailing Address - Fax:847-598-5438
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 704
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2437
Practice Address - Country:US
Practice Address - Phone:224-326-2203
Practice Address - Fax:847-598-5438
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01-0738-19103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst