Provider Demographics
NPI:1457682411
Name:CHICAGO BEHAVIOR DEVELOPMENT
Entity Type:Organization
Organization Name:CHICAGO BEHAVIOR DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SMAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-520-4657
Mailing Address - Street 1:4677 N VIRGINIA AVE
Mailing Address - Street 2:UNIT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2953
Mailing Address - Country:US
Mailing Address - Phone:312-520-4657
Mailing Address - Fax:
Practice Address - Street 1:4677 N VIRGINIA AVE
Practice Address - Street 2:UNIT 1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2953
Practice Address - Country:US
Practice Address - Phone:312-520-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty