Provider Demographics
NPI:1275906786
Name:INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES
Entity Type:Organization
Organization Name:INSTRUCTIONAL ABA CONSULTANTS WAIVER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOPALOV
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:630-441-5077
Mailing Address - Street 1:1260 IROQUOIS AVE
Mailing Address - Street 2:#306
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1689
Mailing Address - Country:US
Mailing Address - Phone:630-441-5077
Mailing Address - Fax:331-229-8843
Practice Address - Street 1:1260 IROQUOIS AVE
Practice Address - Street 2:#306
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1689
Practice Address - Country:US
Practice Address - Phone:630-441-5077
Practice Address - Fax:331-229-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1119270251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health