Provider Demographics
NPI:1649605213
Name:MARTIN, VENTZISLAVA (BCBA)
Entity type:Individual
Prefix:
First Name:VENTZISLAVA
Middle Name:
Last Name:MARTIN
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 1:26804 BASSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2932
Mailing Address - Country:US
Mailing Address - Phone:630-404-6545
Mailing Address - Fax:
Practice Address - Street 1:6860 N FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7828
Practice Address - Country:US
Practice Address - Phone:331-210-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst