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General NPI Number Information
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NPI Number | 1861207474
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE THERAPY LLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 415 W GOLF RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-3929
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Country | US
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Telephone | 224-703-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 N MITCHELL AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4652
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Country | US
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Telephone | 224-703-5780
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR SPECIALIST
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Name | MRS. SVETLANA JARDAN
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Credential | BCBA
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Telephone | 224-703-5780
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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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