Provider Demographics
NPI:1063957561
Name:COCHRAN, AMY (BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COCHRAN
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 1:4216 CHESAPEAKE DR
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5148
Mailing Address - Country:US
Mailing Address - Phone:630-730-7991
Mailing Address - Fax:
Practice Address - Street 1:5 REVERE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1566
Practice Address - Country:US
Practice Address - Phone:847-807-3717
Practice Address - Fax:847-348-3706
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-24411103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst