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General NPI Number Information
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NPI Number | 1861211799
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Entity Type | Individual
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Provider Name | CHRISTOPHER SIMPSON
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Gender | Male
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2121 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-4031
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Country | US
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Telephone | 773-902-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 N SANDBURG TER
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City | CHICAGO
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State | IL
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Zip | 60610-1566
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Country | US
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Telephone | 630-687-2116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | BACB750193
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License Number State | IL
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