Provider Demographics
NPI:1134983075
Name:ANSONG, CHELSEA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:ANSONG
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-7892
Mailing Address - Country:US
Mailing Address - Phone:917-946-5179
Mailing Address - Fax:
Practice Address - Street 1:2521 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-7892
Practice Address - Country:US
Practice Address - Phone:917-046-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-71043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst