Provider Demographics
NPI:1578085304
Name:MEYER, VICTORIA (BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:VENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:718 OGDEN AVE UPPR 201
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:718 OGDEN AVE UPPR 201
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2959
Practice Address - Country:US
Practice Address - Phone:312-554-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118239103K00000X
IL1-18-31141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst