MEDICARE: FOX VALLEY BEHAVIORAL 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	1010524	IL

General Provider Information

NPI Number	:	1477815959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY BEHAVIORAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	1609 WATERFORD RD
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1741
Country	:	US
Telephone Number	:	312-865-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 WATERFORD RD
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1741
Country	:	US
Telephone Number	:	312-865-1677
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/SENIOR BEHAVIOR ANALYST
Name	:	JEANNE BROWER
Credential	:	BCBA
Telephone Number	:	312-865-1677

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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