Provider Demographics
NPI:1942666045
Name:SMITH, OLIVIA L (BCBA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:BCBA
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Mailing Address - Street 1:950 LEE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6532
Mailing Address - Country:US
Mailing Address - Phone:877-486-4140
Mailing Address - Fax:847-486-4145
Practice Address - Street 1:12075 CORPORATE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-2664
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:847-486-4145
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2018-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL1-15-19887103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI129-140OtherSTATE OF WISCONSIN