Provider Demographics
NPI:1447839089
Name:NELSON, MADELYN NADINE (BCBA)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:NADINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:MADELYN
Other - Middle Name:NADINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:245 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3739
Mailing Address - Country:US
Mailing Address - Phone:888-308-3728
Mailing Address - Fax:
Practice Address - Street 1:4112 FIELDSTONE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6182
Practice Address - Country:US
Practice Address - Phone:888-308-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-140248106S00000X
IL1-23-67437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician