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General NPI Number Information
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NPI Number | 1245585777
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Entity Type | Organization
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Legal Business Name | WESTSIDE ABA
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 10257 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-469-1500
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Fax | 815-469-1518
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Provider Business Mailing Address
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Address Line | 10257 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-469-1500
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Fax | 815-469-1518
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | SHARI SCHEDIN CASSIDY
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Credential | PT
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Telephone | 815-469-1500
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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 | 11210328
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License Number State | IL
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