Provider Demographics
NPI:1629341433
Name:AUTISM BEHAVIOR & CHILDHOOD SERVICE, INC.
Entity Type:Organization
Organization Name:AUTISM BEHAVIOR & CHILDHOOD SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY M, BCBA
Authorized Official - Phone:312-420-2093
Mailing Address - Street 1:13664 ANNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:312-420-2093
Mailing Address - Fax:331-318-8415
Practice Address - Street 1:13664 ANNE DRIVE
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:312-420-2093
Practice Address - Fax:331-318-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093017394Medicaid