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General NPI Number Information
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NPI Number | 1790264927
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Entity Type | Organization
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Legal Business Name | INDEPENDENT WITH AUTISM
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 100 SAUNDERS RD STE 150
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City | LAKE FOREST
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State | IL
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Zip | 60045-2526
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Country | US
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Telephone | 847-275-9413
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Fax |
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Provider Business Mailing Address
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Address Line | 2549 WAUKEGAN RD STE 55
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1569
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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 | OWNER
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Name | MS. SUSAN PERKOWITZ
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Credential |
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Telephone | 847-274-9413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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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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