Provider Demographics
NPI:1558818930
Name:AUTISMCHICAGO
Entity Type:Organization
Organization Name:AUTISMCHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BAHAVIORAL HEALTH TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MAP, BCBA, RBT
Authorized Official - Phone:773-595-5168
Mailing Address - Street 1:8035 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3516
Mailing Address - Country:US
Mailing Address - Phone:773-595-5168
Mailing Address - Fax:
Practice Address - Street 1:8035 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3516
Practice Address - Country:US
Practice Address - Phone:773-595-5168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services