Healthcare Provider Details

I. General information

NPI: 1982077194
Provider Name (Legal Business Name): CHICAGO AUTISM & BEHAVIOR SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W HAWTHORN DR
ITASCA IL
60143-2056
US

IV. Provider business mailing address

901 W HAWTHORN DR
ITASCA IL
60143-2056
US

V. Phone/Fax

Practice location:
  • Phone: 800-844-1232
  • Fax: 800-844-1232
Mailing address:
  • Phone: 800-844-1232
  • Fax: 800-844-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1831348028
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1821203100
License Number StateIL

VIII. Authorized Official

Name: SARAH WASNICK
Title or Position: BILLING SPECIALIST
Credential:
Phone: 800-844-1232