NPI 1003110628

Victor P Fuller

Practitioner Behavior Analyst Flossmoor, IL

Practice location

Address: 19530 Kedzie Ave, Flossmoor, IL 60422-1778
Phone: (708) 754-8815
Mailing address: 16278 Prince Dr, South Holland, IL 60473-3233

Registered specialties

Behavior Analyst Primary

Behavioral Health & Social Service Providers Taxonomy 103K00000X

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Registry record

NPI: 1003110628
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Dec 2010
Record last updated: 23 Dec 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.