Provider Demographics
NPI:1710375969
Name:KIDNECTIVITY
Entity Type:Organization
Organization Name:KIDNECTIVITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-239-2177
Mailing Address - Street 1:600 WAUKEGAN RD STE 132
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1249
Mailing Address - Country:US
Mailing Address - Phone:847-748-8733
Mailing Address - Fax:
Practice Address - Street 1:600 WAUKEGAN RD STE 132
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1249
Practice Address - Country:US
Practice Address - Phone:847-748-8733
Practice Address - Fax:847-739-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005840225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty