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General NPI Number Information
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NPI Number | 1588173397
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Entity Type | Organization
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Legal Business Name | CRABTREE CONSULTING OF ILLINOIS INC
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 6632 N SIOUX AVE
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City | CHICAGO
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State | IL
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Zip | 60646-2821
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Country | US
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Telephone | 773-793-6223
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Fax |
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Provider Business Mailing Address
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Address Line | 6632 N SIOUX AVE
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City | CHICAGO
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State | IL
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Zip | 60646-2821
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Country | US
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Telephone | 773-793-6223
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN THOMAS CRABTREE
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Credential |
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Telephone | 773-793-6223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | BC71920812P
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License Number State | IL
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