Healthcare Provider Details

I. General information

NPI: 1649711573
Provider Name (Legal Business Name): AUTISM BEHAVIOR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2017
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 KRAML DR
BURR RIDGE IL
60527-0303
US

IV. Provider business mailing address

124 KRAML DR
BURR RIDGE IL
60527-0303
US

V. Phone/Fax

Practice location:
  • Phone: 630-631-9623
  • Fax: 630-920-0522
Mailing address:
  • Phone: 630-631-9623
  • Fax: 630-920-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11520882
License Number StateIL

VIII. Authorized Official

Name: MRS. SHADEN S KASSAR
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA
Phone: 630-631-9623