Provider Demographics
NPI:1891269171
Name:CROSS, BAILEY ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN
Last Name:CROSS
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 1:255 38TH AVE STE F-I
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5411
Mailing Address - Country:US
Mailing Address - Phone:630-509-8700
Mailing Address - Fax:
Practice Address - Street 1:255 38TH AVE STE F-I
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5411
Practice Address - Country:US
Practice Address - Phone:630-509-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-29907106S00000X
1-23-68231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician