Provider Demographics
NPI:1184126823
Name:BUDZYN, CELESTE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:BUDZYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:PLAUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA 1-19-36720
Mailing Address - Street 1:5 REVERE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8005
Mailing Address - Country:US
Mailing Address - Phone:847-807-3717
Mailing Address - Fax:
Practice Address - Street 1:5 REVERE DR STE 120
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8005
Practice Address - Country:US
Practice Address - Phone:847-247-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL15-10392106S00000X
1-19-36720103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician