Provider Demographics
NPI:1649773839
Name:TESKE, DARON MICHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:DARON
Middle Name:MICHELLE
Last Name:TESKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W IRVING PARK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3592
Mailing Address - Country:US
Mailing Address - Phone:847-373-0393
Mailing Address - Fax:
Practice Address - Street 1:3000 W IRVING PARK RD STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3592
Practice Address - Country:US
Practice Address - Phone:847-373-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-51352106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician