Healthcare Provider Details

I. General information

NPI: 1447102330
Provider Name (Legal Business Name): OAK PARK AUTISM CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121A NORTH AVE
OAK PARK IL
60302-1002
US

IV. Provider business mailing address

7121A NORTH AVE
OAK PARK IL
60302-1002
US

V. Phone/Fax

Practice location:
  • Phone: 708-270-1665
  • Fax: 872-260-0900
Mailing address:
  • Phone: 708-270-1665
  • Fax: 872-260-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARRISSA WEAKLEY
Title or Position: CREDENTIALING AND BILLING SPEC
Credential:
Phone: 779-348-9850