Provider Demographics
NPI:1548772288
Name:MEETAM, NANNAPAT (BCBA)
Entity Type:Individual
Prefix:MS
First Name:NANNAPAT
Middle Name:
Last Name:MEETAM
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 1:8421 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-2119
Mailing Address - Country:US
Mailing Address - Phone:708-655-4252
Mailing Address - Fax:
Practice Address - Street 1:8200 185TH ST STE AB
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9232
Practice Address - Country:US
Practice Address - Phone:708-580-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL1-20-41175103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician