Provider Demographics
NPI:1962168971
Name:AGUILAR, ALEXIS MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:AGUILAR
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 1:666 DUNDEE RD STE 1605
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2738
Mailing Address - Country:US
Mailing Address - Phone:847-495-2640
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD STE 1605
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2738
Practice Address - Country:US
Practice Address - Phone:847-495-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-55447103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst