MEDICARE: CHRISTINA ASHLEY PARKS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1932914124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ASHLEY PARKS

Provider Business Mailing Address
First Line	:	5450 W FERDINAND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-1938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 W FERDINAND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-1938
Country	:	US
Telephone Number	:	773-680-2399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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Directions to “ CHRISTINA ASHLEY PARKS ” Practice Location

Language	Start Address	Practice Location

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