=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639025695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVYREHAB ILLINOIS ABA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1864 JOHNS DR
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-1657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-610-9481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 MAMARONECK AVE STE 140
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. DIRECTOR OF PROVIDER RELATIONS
-----------------------------------------------------
Name | ASHLEY GRIFFITHS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-678-6119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------