Provider Demographics
NPI:1982316006
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:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-716-5033
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:247-165-0332
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:224-716-5033
Practice Address - Fax:224-643-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty