| Early Autism Services, Llc | |
|
5705 Willow Springs Rd Countryside IL 60525-3478 | |
| (312) 914-0611 | |
| (312) 929-0324 |
| Full Name | Early Autism Services, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 5705 Willow Springs Rd, Countryside, Illinois |
| Authorized Official Name and Position | Benjamin Wessels (OWNER) |
| Authorized Official Contact | 3129652997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Early Autism Services, Llc 640 Grassmere Park Ste 116 Nashville TN 37211-3678 Ph: (312) 914-0611 | Early Autism Services, Llc 5705 Willow Springs Rd Countryside IL 60525-3478 Ph: (312) 914-0611 |
| NPI Number | 1700130713 |
|---|---|
| Provider Enumeration Date | 10/30/2012 |
| Last Update Date | 07/21/2022 |
| Certification Date | 04/11/2022 |
| Medicare PECOS PAC ID | 9436547288 |
|---|---|
| Medicare Enrollment ID | O20211027001143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700130713 | NPI | - | NPPES |
| Provider Name | Katherine Jones |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1639746639 PECOS PAC ID: 5698163442 Enrollment ID: I20211027001276 |
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