| Blue Bolt Pediatric Care | |
|
800 Elgin Rd Apt 1218 Evanston IL 60201-5628 | |
| (917) 580-2599 | |
| Not Available |
| Full Name | Blue Bolt Pediatric Care |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 800 Elgin Rd Apt 1218, Evanston, Illinois |
| Authorized Official Name and Position | Emily Groben (BOARD CERTIFIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 9175802599 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Bolt Pediatric Care 1555 Sherman Ave # 324 Evanston IL 60201-4421 Ph: () - | Blue Bolt Pediatric Care 800 Elgin Rd Apt 1218 Evanston IL 60201-5628 Ph: (917) 580-2599 |
| NPI Number | 1093551350 |
|---|---|
| Provider Enumeration Date | 07/06/2024 |
| Last Update Date | 07/06/2024 |
| Certification Date | 07/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093551350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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