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General NPI Number Information
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NPI Number | 1962716365
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Entity Type | Organization
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Legal Business Name | AUTISM INTERVENTIONS, INC.
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 3921 N MOZART ST
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City | CHICAGO
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State | IL
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Zip | 60618-3619
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Country | US
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Telephone | 630-886-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 N MOZART ST
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City | CHICAGO
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State | IL
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Zip | 60618-3619
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Country | US
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Telephone | 630-886-8375
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Fax |
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | TINA M CROSS
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Credential | D.T.
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Telephone | 630-886-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | TC92450503P
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License Number State | IL
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