Provider Demographics
NPI:1780253930
Name:RESCO, MISTY DAWN (RBT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:RESCO
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 1:1130 FOXGLOVE CT
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8251
Mailing Address - Country:US
Mailing Address - Phone:815-370-9824
Mailing Address - Fax:
Practice Address - Street 1:1130 FOXGLOVE CT
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8251
Practice Address - Country:US
Practice Address - Phone:815-370-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-20-149801106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty