Northwest Autism Diagnostic Center, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

NORTHWEST AUTISM DIAGNOSTIC CENTER, LLC

Practice address

394 Federal Dr
Crystal Lake, IL 60014-6281

Phone

(224) 206-5415

NPI assigned

Sep 25, 2020

Organization subpart

No

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

Authorized official

Name

Courtney Dirksen, PHD

Title

Owner

Phone

(224) 206-5415

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1528675329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2257",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463040357",
            "telephone_number": "219-926-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 FEDERAL DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146281",
            "telephone_number": "224-206-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST AUTISM DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "DIRKSEN",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-206-5415",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.