Healthcare Provider Details

I. General information

NPI: 1235830803
Provider Name (Legal Business Name): AUTISM BEHAVIOR CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 HILLCREST DR
BURR RIDGE IL
60527-5793
US

IV. Provider business mailing address

6445 HILLCREST DR
BURR RIDGE IL
60527-5793
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-8070
  • Fax:
Mailing address:
  • Phone: 708-209-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: REEMA HAMADEH
Title or Position: PRESIDENT
Credential:
Phone: 708-209-8070