Healthcare Provider Details

I. General information

NPI: 1659928687
Provider Name (Legal Business Name): SWIFT ACHIEVEMENTS ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 COMMERCIAL ST UNIT B
EDWARDSVILLE IL
62025-1608
US

IV. Provider business mailing address

209 COMMERCIAL ST UNIT B
EDWARDSVILLE IL
62025-1608
US

V. Phone/Fax

Practice location:
  • Phone: 618-741-1066
  • Fax:
Mailing address:
  • Phone: 618-741-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN E HODSKINS
Title or Position: OWNER/BEHAVIOR ANALYST
Credential: BCBA
Phone: 618-741-1066