Provider Demographics
NPI:1912661646
Name:MCGINNIS, NICOLE ROSE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2925
Mailing Address - Country:US
Mailing Address - Phone:312-806-7937
Mailing Address - Fax:
Practice Address - Street 1:6430 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2925
Practice Address - Country:US
Practice Address - Phone:312-806-7937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst