Provider Demographics
NPI:1568662740
Name:CSQUARED PEDIATRIC DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:CSQUARED PEDIATRIC DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISHON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:866-450-8777
Mailing Address - Street 1:1448 E 52ND ST
Mailing Address - Street 2:SUITE #161
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4122
Mailing Address - Country:US
Mailing Address - Phone:866-450-8777
Mailing Address - Fax:877-588-6007
Practice Address - Street 1:1448 E 52ND ST
Practice Address - Street 2:SUITE #161
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4122
Practice Address - Country:US
Practice Address - Phone:866-450-8777
Practice Address - Fax:877-588-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCW71491203P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty