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General NPI Number Information
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NPI Number | 1083010342
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Entity Type | Organization
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Legal Business Name | BRIDGES ACADEMY, LLC
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 5911 N LEADER AVE
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City | CHICAGO
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State | IL
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Zip | 60646-5625
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Country | US
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Telephone | 773-332-7382
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Fax | 773-305-0915
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Provider Business Mailing Address
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Address Line | 5911 N LEADER AVE
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City | CHICAGO
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State | IL
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Zip | 60646-5625
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Country | US
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Telephone | 773-332-7382
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Fax | 773-305-0915
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAYME L CROOKS
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Credential | MA, BCBA
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Telephone | 773-332-7382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 10-7278
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10-7278
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License Number State | IL
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