Provider Demographics
NPI:1629899109
Name:SKUPIEN, PATRYCJA ARLETA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:PATRYCJA
Middle Name:ARLETA
Last Name:SKUPIEN
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 1:8609 W BRYN MAWR AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3524
Mailing Address - Country:US
Mailing Address - Phone:773-644-7787
Mailing Address - Fax:
Practice Address - Street 1:3033 W JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:773-644-7787
Practice Address - Fax:224-241-3123
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-75950103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty