Healthcare Provider Details

I. General information

NPI: 1083138358
Provider Name (Legal Business Name): EARLY DYNAMICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 N NORDICA AVE
CHICAGO IL
60656-3606
US

IV. Provider business mailing address

5116 N NORDICA AVE
CHICAGO IL
60656-3606
US

V. Phone/Fax

Practice location:
  • Phone: 773-750-0982
  • Fax:
Mailing address:
  • Phone: 773-750-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: HILDA ESTRADA
Title or Position: OWNER
Credential: NONE
Phone: 773-750-0982