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NPI Code Detail

MEDICARE: ASSOCIATION FOR INDIVIDUAL DEVELOPMENT

MEDICARE: ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1457179293
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
Provider Business Mailing Address
First Line : 309 NEW INDIAN TRAIL CT
Second Line :
City : AURORA
State : IL
Zip : 60506-2411
Country : US
Telephone Number : 630-966-4000
Fax Number : 630-844-2065
Provider Business Practice Location Address
First Line : 121 SARAVANOS RD STE 2
Second Line :
City : YORKVILLE
State : IL
Zip : 60560-5813
Country : US
Telephone Number : 630-966-4461
Fax Number : 630-882-8409
Authorized Official
Title or Position : CEO
Name : FRANCES LORE BAKER
Credential :
Telephone Number : 630-966-4001
Provider Enumeration Date : 10/01/2024
Last Update Date : 10/01/2024

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1649035627 — ASSOCIATION FOR INDIVIDUAL DEVELOPMENT
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Directions to “ASSOCIATION FOR INDIVIDUAL DEVELOPMENT ” Practice Location

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