Healthcare Provider Details

I. General information

NPI: 1891326773
Provider Name (Legal Business Name): BERIKISU ATOJOKO LEVEL 11 AUTISM THER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 OLD RENWICK CIR
PLAINFIELD IL
60544-2246
US

IV. Provider business mailing address

2953 OLD RENWICK CIR
PLAINFIELD IL
60544-2246
US

V. Phone/Fax

Practice location:
  • Phone: 815-416-8198
  • Fax:
Mailing address:
  • Phone: 815-416-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: