Provider Demographics
NPI:1215315106
Name:TERESI, KATHLEEN MARY (MA ED BCBA)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:TERESI
Suffix:
Gender:F
Credentials:MA ED BCBA
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:TERESI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7600 SEQUOIA CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4239
Mailing Address - Country:US
Mailing Address - Phone:708-715-4656
Mailing Address - Fax:
Practice Address - Street 1:7600 SEQUOIA CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4239
Practice Address - Country:US
Practice Address - Phone:708-715-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-14-15682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst