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NPI Code Detail

MEDICARE: ABA MIDWEST EDUCATION LTD

MEDICARE: ABA MIDWEST EDUCATION LTD
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
1103K00000XBehavior Analyst1-118506IL
2103TC0700XClinical Psychologist071-004663IL
3103TM1800XIntellectual & Developmental Disabilities Psychologist1-031395IL
4103TM1800XIntellectual & Developmental Disabilities Psychologist071-004663IL
5103K00000XBehavior Analyst1-031395IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11114025434OTHERILLCP, ILLINOIS
21407069941OTHERBEHAVIORAL ANALYST

General Provider Information

NPI Number : 1891088290
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABA MIDWEST EDUCATION LTD
Provider Business Mailing Address
First Line : 1136 S DELANO CT W B201
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 312-375-1000
Fax Number : 773-326-0725
Provider Business Practice Location Address
First Line : 1136 S DELANO CT W B201
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 312-375-1000
Fax Number : 773-326-0725
Authorized Official
Title or Position : BOARD CERTIFIED BEHAVIOR ANALYST
Name : MS. JANICE MARIE PELLECCHIA
Credential : B.C.B.A, M.A.
Telephone Number : 312-375-1000
Provider Enumeration Date : 05/18/2011
Last Update Date : 09/18/2019

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