Provider Demographics
NPI:1811681125
Name:ACADIA PEDIATRIC THERAPY
Entity type:Organization
Organization Name:ACADIA PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-260-7525
Mailing Address - Street 1:36880 N DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6731
Mailing Address - Country:US
Mailing Address - Phone:815-260-7525
Mailing Address - Fax:
Practice Address - Street 1:1015 N CORPORATE CIR STE A
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7813
Practice Address - Country:US
Practice Address - Phone:247-165-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center