| Shawnee Behavioral Consultation Llc | |
|
224 Belden Dr Edwardsville IL 62025-3178 | |
| (618) 977-2773 | |
| (312) 626-2429 |
| Full Name | Shawnee Behavioral Consultation Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 224 Belden Dr, Edwardsville, Illinois |
| Authorized Official Name and Position | Christina Ann Ruzicka (BOARD CERTIFIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 6189772773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Behavioral Consultation Llc 7384 Sharp Ave Saint Louis MO 63116-3040 Ph: (618) 977-2773 | Shawnee Behavioral Consultation Llc 224 Belden Dr Edwardsville IL 62025-3178 Ph: (618) 977-2773 |
| NPI Number | 1356611024 |
|---|---|
| Provider Enumeration Date | 01/11/2012 |
| Last Update Date | 01/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356611024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1084838 (Illinois) | Primary |
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