Provider Demographics
NPI:1538603329
Name:VALESEY, MEGAN KATERI (BCBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATERI
Last Name:VALESEY
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 1:847 N MILWAUKEE AVE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4145
Mailing Address - Country:US
Mailing Address - Phone:845-264-2510
Mailing Address - Fax:
Practice Address - Street 1:12745 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1130
Practice Address - Country:US
Practice Address - Phone:708-722-2384
Practice Address - Fax:708-563-2125
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
IL1-17-27261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst