Provider Demographics
NPI:1881184919
Name:SWANSON, BILLIE NOELL (RBT-18-47448)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:NOELL
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RBT-18-47448
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 E LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8398
Mailing Address - Country:US
Mailing Address - Phone:815-403-6806
Mailing Address - Fax:
Practice Address - Street 1:4108 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WONDER LAKE
Practice Address - State:IL
Practice Address - Zip Code:60097-8398
Practice Address - Country:US
Practice Address - Phone:815-403-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-47448106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician