Provider Demographics
NPI:1255031381
Name:RAMESHKUMAR, SRUTHI (BCBA)
Entity type:Individual
Prefix:MS
First Name:SRUTHI
Middle Name:
Last Name:RAMESHKUMAR
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 1:2328 SPIKE HORN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4316
Mailing Address - Country:US
Mailing Address - Phone:630-656-7012
Mailing Address - Fax:
Practice Address - Street 1:2600 WARRENVILLE RD STE 212
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1761
Practice Address - Country:US
Practice Address - Phone:630-442-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-50394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst