Healthcare Provider Details

I. General information

NPI: 1700130713
Provider Name (Legal Business Name): EARLY AUTISM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 WILLOW SPRINGS RD
COUNTRYSIDE IL
60525-3478
US

IV. Provider business mailing address

1721 MOON LAKE BLVD STE 140
HOFFMAN ESTATES IL
60169-1070
US

V. Phone/Fax

Practice location:
  • Phone: 312-914-0611
  • Fax: 312-929-0324
Mailing address:
  • Phone: 312-965-2997
  • Fax: 312-929-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WESSELS
Title or Position: OWNER
Credential:
Phone: 312-965-2997