Healthcare Provider Details

I. General information

NPI: 1891088290
Provider Name (Legal Business Name): ABA MIDWEST EDUCATION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 S DELANO CT W B201
CHICAGO IL
60605-3734
US

IV. Provider business mailing address

1136 S DELANO CT W B201
CHICAGO IL
60605-3734
US

V. Phone/Fax

Practice location:
  • Phone: 312-375-1000
  • Fax: 773-326-0725
Mailing address:
  • Phone: 312-375-1000
  • Fax: 773-326-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-118506
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004663
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1-031395
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number071-004663
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-031395
License Number StateIL

VIII. Authorized Official

Name: MS. JANICE MARIE PELLECCHIA
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: B.C.B.A, M.A.
Phone: 312-375-1000