Provider Demographics
NPI:1104578954
Name:ANCONA, LINDSEY (BCBA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:ANCONA
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 1:5S641 BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3835
Mailing Address - Country:US
Mailing Address - Phone:630-251-7813
Mailing Address - Fax:
Practice Address - Street 1:2910 FINLEY RD # 102
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1042
Practice Address - Country:US
Practice Address - Phone:630-495-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-55938103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst