Provider Demographics
NPI:1427425412
Name:BOUTAIN, ARIANA (BCBA-D)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:
Last Name:BOUTAIN
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 LACI CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN CREEK
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3279
Mailing Address - Country:US
Mailing Address - Phone:224-326-2209
Mailing Address - Fax:847-498-5438
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 704
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2437
Practice Address - Country:US
Practice Address - Phone:224-326-2206
Practice Address - Fax:224-220-5160
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB232985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty