Provider Demographics
NPI:1891206298
Name:THIEMAN, TERRI (BCBA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:THIEMAN
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 1:213 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-4003
Mailing Address - Country:US
Mailing Address - Phone:630-862-9656
Mailing Address - Fax:630-862-9656
Practice Address - Street 1:213 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-4003
Practice Address - Country:US
Practice Address - Phone:630-862-9656
Practice Address - Fax:630-862-9656
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-27684103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst