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General NPI Number Information
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NPI Number | 1447102330
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Entity Type | Organization
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Legal Business Name | OAK PARK AUTISM CLINIC INC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 7121A NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1002
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Country | US
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Telephone | 708-270-1665
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Fax | 872-260-0900
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Provider Business Mailing Address
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Address Line | 7121A NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1002
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Country | US
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Telephone | 708-270-1665
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Fax | 872-260-0900
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Authorized Official
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Title or Position | CREDENTIALING AND BILLING SPEC
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Name | CARRISSA WEAKLEY
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Credential |
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Telephone | 779-348-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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