MEDICARE: EB PEDIATRIC RESOURCES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	235Z00000X	Speech-Language Pathologist
3	103K00000X	Behavior Analyst
4	222Q00000X	Developmental Therapist
5	225X00000X	Occupational Therapist
6	225XP0200X	Pediatric Occupational Therapist
7	2251P0200X	Pediatric Physical Therapist
8	103T00000X	Psychologist
9	1041C0700X	Clinical Social Worker
10	104100000X	Social Worker
11	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1790975266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EB PEDIATRIC RESOURCES INC

Provider Business Mailing Address
First Line	:	3712 N BROADWAY ST # 250
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 N BROADWAY ST # 250
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4235
Country	:	US
Telephone Number	:	773-615-3202
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH BENNEY
Credential	:	MA DT CIMI
Telephone Number	:	773-615-3202

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	08/31/2015

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