Provider Demographics
NPI:1649431479
Name:KLIMOWSKI, THERESA LYNNE (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNNE
Last Name:KLIMOWSKI
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 W 98TH PL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2614
Mailing Address - Country:US
Mailing Address - Phone:630-248-6632
Mailing Address - Fax:
Practice Address - Street 1:2815 W 98TH PL
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2614
Practice Address - Country:US
Practice Address - Phone:630-248-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-04-1753171M00000X
1-04-1753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator