MEDICARE: JOYFUL 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	:	1295519916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOYFUL ABA LLC

Provider Business Mailing Address
First Line	:	2045 W GRAND AVE STE B292316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	708-625-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W GRAND AVE STE B292316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	708-625-4836
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE SMITH
Credential	:
Telephone Number	:	708-625-4836

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	03/16/2026

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