Provider Demographics
NPI:1992187504
Name:HEIGHTENED POTENTIAL COMPANY
Entity Type:Organization
Organization Name:HEIGHTENED POTENTIAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BONINE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, HPCS
Authorized Official - Phone:630-408-5845
Mailing Address - Street 1:2956 BASE LINE RD
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146-8702
Mailing Address - Country:US
Mailing Address - Phone:630-408-5845
Mailing Address - Fax:855-710-7745
Practice Address - Street 1:2956 BASE LINE RD
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:IL
Practice Address - Zip Code:60146-8702
Practice Address - Country:US
Practice Address - Phone:630-408-5845
Practice Address - Fax:855-710-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEM82450304P252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency