MEDICARE: LITTLE FRIENDS CENTER FOR AUTISM, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194959767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE FRIENDS CENTER FOR AUTISM, INC.

Provider Business Mailing Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	SUITE 151
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-305-6039
Fax Number	:	630-355-3176

Provider Business Practice Location Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	SUITE 151
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-305-6039
Fax Number	:	630-355-3176

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	PATTI BOHEME
Credential	:	M.S., L.C.P.C.
Telephone Number	:	630-305-6039

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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