Provider Demographics
NPI:1942454681
Name:PINGO, JOHN (BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PINGO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4596 SADDLE ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5335
Mailing Address - Country:US
Mailing Address - Phone:815-985-8465
Mailing Address - Fax:
Practice Address - Street 1:58 W ROCKTON RD
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-1631
Practice Address - Country:US
Practice Address - Phone:815-624-8431
Practice Address - Fax:815-624-8461
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst