Provider Demographics
NPI:1568078863
Name:FAHY, KATHRYN (MA, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:
Last Name:FAHY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 BOB O LINK RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4123
Mailing Address - Country:US
Mailing Address - Phone:708-476-8907
Mailing Address - Fax:
Practice Address - Street 1:6860 N FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7828
Practice Address - Country:US
Practice Address - Phone:331-210-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
IL1-22-62214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician