MEDICARE: PROGRESS ROAD ABA LLC

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1104776806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS ROAD ABA LLC

Provider Business Mailing Address
First Line	:	7055 CONDOR DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2951
Country	:	US
Telephone Number	:	440-591-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 CONDOR DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2951
Country	:	US
Telephone Number	:	440-591-8156
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	AMY RIES
Credential	:
Telephone Number	:	440-591-8156

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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