Provider Demographics
NPI:1336690239
Name:360 YOUTH SERVICES
Entity Type:Organization
Organization Name:360 YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUJAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-541-7219
Mailing Address - Street 1:1548 BOND ST STE 114
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6509
Mailing Address - Country:US
Mailing Address - Phone:630-717-9408
Mailing Address - Fax:630-596-8496
Practice Address - Street 1:1548 BOND ST STE 114
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6509
Practice Address - Country:US
Practice Address - Phone:630-717-9408
Practice Address - Fax:630-596-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty