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NPI Code Detail

MEDICARE: INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES

MEDICARE: INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1871252817
Entity Type Code : Organization
Provider Name (Legal Business Name) : INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES
Provider Business Mailing Address
First Line : 1975 MC DOWELL RD STE 101
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-6533
Country : US
Telephone Number : 331-229-8839
Fax Number : 331-256-1900
Provider Business Practice Location Address
First Line : 1975 MC DOWELL RD STE 101
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-6533
Country : US
Telephone Number : 331-229-8839
Fax Number : 331-256-1900
Authorized Official
Title or Position : CEO
Name : JESSICA K TOPALOV
Credential :
Telephone Number : 630-601-3151
Provider Enumeration Date : 12/16/2021
Last Update Date : 12/16/2021

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Directions to “INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES ” Practice Location

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