Provider Demographics
NPI:1457812141
Name:MCNEILL, KAITLIN LOUISA (MADS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LOUISA
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MADS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W OAKDALE AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5950
Mailing Address - Country:US
Mailing Address - Phone:773-505-8035
Mailing Address - Fax:
Practice Address - Street 1:1422 W WILLOW ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8977
Practice Address - Country:US
Practice Address - Phone:312-399-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst