Provider Demographics
NPI:1861984320
Name:MENEGHINI, JOHN (RBT-17-29037)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MENEGHINI
Suffix:
Gender:M
Credentials:RBT-17-29037
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4700
Mailing Address - Country:US
Mailing Address - Phone:708-846-7597
Mailing Address - Fax:
Practice Address - Street 1:3429 S UNION AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4700
Practice Address - Country:US
Practice Address - Phone:708-846-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-29037106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician