Provider Demographics
NPI:1013764356
Name:WILDFLOWER AUTISM SERVICES
Entity type:Organization
Organization Name:WILDFLOWER AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:815-600-1430
Mailing Address - Street 1:4591 W HIGGINS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-3718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4591 W HIGGINS RD STE 120
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3718
Practice Address - Country:US
Practice Address - Phone:815-600-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty