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General NPI Number Information
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NPI Number | 1164389268
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Entity Type | Organization
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Legal Business Name | ABA REVOLUTION
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 2700 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3920
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Country | US
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Telephone | 224-491-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 3007 W LAWRENCE AVE APT 2W
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City | CHICAGO
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State | IL
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Zip | 60625-7375
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RBT
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Name | JACK CORBETT
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Credential |
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Telephone | 872-325-7113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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