Provider Demographics
NPI:1477960508
Name:EARLY INTERVENTION FOR AUTISM, LLC.
Entity Type:Organization
Organization Name:EARLY INTERVENTION FOR AUTISM, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MIHM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:847-915-0164
Mailing Address - Street 1:2452 VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8032
Mailing Address - Country:US
Mailing Address - Phone:847-915-0164
Mailing Address - Fax:
Practice Address - Street 1:2452 VIOLET ST
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8032
Practice Address - Country:US
Practice Address - Phone:847-915-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7063103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty