MEDICARE: ROOTS AUTISM SOLUTIONS, 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	:	1447606942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS AUTISM SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	160 LEXINGTON DR STE B
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6929
Country	:	US
Telephone Number	:	224-676-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 LEXINGTON DR STE B
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6929
Country	:	US
Telephone Number	:	224-676-0202
Fax Number	:	844-726-2721

Authorized Official
Title or Position	:	CO-OWNER / BCBA
Name	:	JENNIFER LINK
Credential	:
Telephone Number	:	224-676-0202

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	02/24/2022

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