Provider Demographics
NPI:1235360249
Name:BAILLIE, SARA JEAN (MA BCBA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:BAILLIE
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W MELROSE ST
Mailing Address - Street 2:APT. 605
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3849
Mailing Address - Country:US
Mailing Address - Phone:708-363-6721
Mailing Address - Fax:
Practice Address - Street 1:422 W MELROSE ST
Practice Address - Street 2:APT. 605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3849
Practice Address - Country:US
Practice Address - Phone:708-363-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-09-5566103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst