Provider Demographics
NPI:1518634724
Name:FIELDS, DANTE LEE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:LEE
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 S FRONTENAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3165
Mailing Address - Country:US
Mailing Address - Phone:331-264-8225
Mailing Address - Fax:
Practice Address - Street 1:892 S FRONTENAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-3165
Practice Address - Country:US
Practice Address - Phone:331-264-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician