Provider Demographics
NPI:1235972035
Name:QUACH, SIRIKANDA (RBT)
Entity type:Individual
Prefix:
First Name:SIRIKANDA
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 GATEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3132
Mailing Address - Country:US
Mailing Address - Phone:312-863-9220
Mailing Address - Fax:
Practice Address - Street 1:4050 HEALTHWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8184
Practice Address - Country:US
Practice Address - Phone:312-863-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-24-352504106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician