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General NPI Number Information
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NPI Number | 1588261705
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Entity Type | Organization
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Legal Business Name | MOBILE THERAPY CENTERS OF IOWA LLC
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 3520 INVERNESS RD
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City | WATERLOO
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State | IA
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Zip | 50701-4634
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Country | US
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Telephone | 847-816-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 854 TECHNOLOGY WAY
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City | LIBERTYVILLE
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State | IL
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Zip | 60048
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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 | CREDENTIALLING SPECIALIST
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Name | JILL SEPULVEDA
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Credential |
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Telephone | 847-816-7200
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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 |
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License Number State |
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