Healthcare Provider Details

I. General information

NPI: 1457192312
Provider Name (Legal Business Name): AUTISM PLANET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ELA RD
LAKE ZURICH IL
60047-2337
US

IV. Provider business mailing address

745 ELA RD
LAKE ZURICH IL
60047-2337
US

V. Phone/Fax

Practice location:
  • Phone: 708-888-4012
  • Fax:
Mailing address:
  • Phone: 708-888-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASMINE WILLIAMSON
Title or Position: OWNER
Credential: BCBA
Phone: 760-484-8805