NPIMap

Organization Active NPI

Autism Support Chicago LLC

  • Behavior Analyst
  • Joliet, IL
National Provider Identifier
1033730791
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
AUTISM SUPPORT CHICAGO LLC
Practice address
401 Burke Dr
Joliet, IL 60433-2113
Phone
(815) 630-6408
Fax
(815) 770-7433
NPI assigned
May 4, 2020
Last updated
May 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leslie Luckey
Title
Credentialing/Billing Manager
Phone
(765) 860-7198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

401 Burke Dr
Joliet, IL 60433-2113

Mailing address

3003 Gari Baldi Way
Spring Hill, TN 37174-6282
Phone (815) 630-6408

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1033730791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 GARI BALDI WAY",
            "city": "SPRING HILL",
            "state": "TN",
            "postal_code": "371746282",
            "telephone_number": "815-630-6408",
            "fax_number": "815-770-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BURKE DR",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604332113",
            "telephone_number": "815-630-6408",
            "fax_number": "815-770-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM SUPPORT CHICAGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-04",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "LUCKEY",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING MANAGER",
        "authorized_official_telephone_number": "765-860-7198"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.