Provider Demographics
NPI:1245055946
Name:MANDEL, DAKOTA (RBT)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E PRAIRIE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3107
Mailing Address - Country:US
Mailing Address - Phone:779-704-9095
Mailing Address - Fax:
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD STE 107
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1588
Practice Address - Country:US
Practice Address - Phone:224-206-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician