Healthcare Provider Details

I. General information

NPI: 1922233923
Provider Name (Legal Business Name): BY YOUR SIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 CASS AVE
DARIEN IL
60561-5314
US

IV. Provider business mailing address

8201 CASS AVE
DARIEN IL
60561-5314
US

V. Phone/Fax

Practice location:
  • Phone: 630-590-5571
  • Fax: 630-326-7175
Mailing address:
  • Phone: 630-590-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW SULLIVAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 630-590-5571