Healthcare Provider Details

I. General information

NPI: 1699145557
Provider Name (Legal Business Name): MONARCH AUTISM THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 10/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 INDIAN HEAD LN
JOLIET IL
60435-1590
US

IV. Provider business mailing address

3611 INDIAN HEAD LN
JOLIET IL
60435-1590
US

V. Phone/Fax

Practice location:
  • Phone: 815-603-8637
  • Fax:
Mailing address:
  • Phone: 815-603-8637
  • 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: CRAIG MARTIN
Title or Position: CFO
Credential:
Phone: 815-603-8637