Healthcare Provider Details

I. General information

NPI: 1831859644
Provider Name (Legal Business Name): COLORFUL MINDS ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 S BLUE ISLAND AVE STE 1
CHICAGO IL
60608-2238
US

IV. Provider business mailing address

1622 S BLUE ISLAND AVE
CHICAGO IL
60608-2238
US

V. Phone/Fax

Practice location:
  • Phone: 773-727-4041
  • Fax:
Mailing address:
  • Phone: 312-584-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: EBONI NIKIA VERNON
Title or Position: CEO
Credential: BCBA
Phone: 312-584-0559