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NPI Code Detail

MEDICARE: AUTISM EVALUATION CENTER AT THE PLACE

MEDICARE: AUTISM EVALUATION CENTER AT THE PLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1104772987
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTISM EVALUATION CENTER AT THE PLACE
Provider Business Mailing Address
First Line : 8609 W BRYN MAWR AVE STE 204
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3524
Country : US
Telephone Number : 773-347-3145
Fax Number : 224-241-3132
Provider Business Practice Location Address
First Line : 8609 W BRYN MAWR AVE STE 204
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3524
Country : US
Telephone Number : 773-347-3145
Fax Number : 224-241-3132
Authorized Official
Title or Position : DIRECTOR OF BILLING DEPT
Name : LLUVIA MARQUEZ
Credential :
Telephone Number : 773-644-7787
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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Directions to “AUTISM EVALUATION CENTER AT THE PLACE ” Practice Location

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