Provider Demographics
NPI:1710213087
Name:LEVY, DAWN JOSETTE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:JOSETTE
Last Name:LEVY
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 1:1441 ARGYLE LN N
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5128
Mailing Address - Country:US
Mailing Address - Phone:815-351-0108
Mailing Address - Fax:
Practice Address - Street 1:111 N CROSSWELL AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2091
Practice Address - Country:US
Practice Address - Phone:815-939-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-17-28806103K00000X
IL1-17-28806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst