Provider Demographics
NPI:1982204988
Name:BUZINSKI, LAUREN NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:BUZINSKI
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 1:31 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1877
Mailing Address - Country:US
Mailing Address - Phone:630-746-0828
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD STE 209
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1727
Practice Address - Country:US
Practice Address - Phone:847-458-8890
Practice Address - Fax:847-458-8889
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-20-43637103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst