Provider Demographics
NPI:1609366160
Name:CHANDLER, JULIANNE MILLAR (RBT-17-45143)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MILLAR
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:RBT-17-45143
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 N DERBYSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5776
Mailing Address - Country:US
Mailing Address - Phone:847-571-9976
Mailing Address - Fax:
Practice Address - Street 1:921 N DERBYSHIRE AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5776
Practice Address - Country:US
Practice Address - Phone:847-571-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-45143106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician