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General NPI Number Information
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NPI Number | 1205219136
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Entity Type | Organization
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Legal Business Name | CHICAGO BEHAVIOR & LEARNING GROUP INC.
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 1737 N WILMOT AVE
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City | CHICAGO
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State | IL
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Zip | 60647-5523
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Country | US
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Telephone | 757-660-9320
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Fax |
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Provider Business Mailing Address
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Address Line | 1737 N WILMOT AVE
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City | CHICAGO
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State | IL
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Zip | 60647-5523
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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 | BCBA/PRESIDENT
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Name | NICOLE JANSMA
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Credential | M.S., BCBA
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Telephone | 757-660-9320
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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 | 1-10-7620
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License Number State | IL
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