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General NPI Number Information
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NPI Number | 1104772987
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Entity Type | Organization
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Legal Business Name | AUTISM EVALUATION CENTER AT THE PLACE
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 8609 W BRYN MAWR AVE STE 204
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City | CHICAGO
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State | IL
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Zip | 60631-3524
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Country | US
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Telephone | 773-347-3145
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Fax | 224-241-3132
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Provider Business Mailing Address
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Address Line | 8609 W BRYN MAWR AVE STE 204
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City | CHICAGO
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State | IL
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Zip | 60631-3524
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Country | US
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Telephone | 773-347-3145
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Fax | 224-241-3132
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Authorized Official
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Title or Position | DIRECTOR OF BILLING DEPT
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Name | LLUVIA MARQUEZ
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Credential |
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Telephone | 773-644-7787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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