=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417856030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARLY AUTISM SERVICES, IL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 MOON LAKE BLVD STE 130-140
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60169-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-965-2997
-----------------------------------------------------
Fax | 312-929-0324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1721 MOON LAKE BLVD STE 140
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60169-1070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-965-2997
-----------------------------------------------------
Fax | 312-929-0324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MORGAN JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-965-2997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------