Provider Demographics
NPI:1861987646
Name:SCHULTZ, DEANNA (RBT-18-58645)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RBT-18-58645
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HANSON DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1141
Mailing Address - Country:US
Mailing Address - Phone:815-662-7294
Mailing Address - Fax:
Practice Address - Street 1:50 HANSON DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1141
Practice Address - Country:US
Practice Address - Phone:815-662-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-58645106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician