Provider Demographics
NPI:1134590938
Name:MILLS, KASEY JEAN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:JEAN
Last Name:MILLS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 W WABANSIA AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5139
Mailing Address - Country:US
Mailing Address - Phone:262-215-1660
Mailing Address - Fax:
Practice Address - Street 1:2948 W WABANSIA AVE
Practice Address - Street 2:APT. 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5139
Practice Address - Country:US
Practice Address - Phone:262-215-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-18132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst