Provider Demographics
NPI:1083010342
Name:BRIDGES ACADEMY, LLC
Entity type:Organization
Organization Name:BRIDGES ACADEMY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:773-332-7382
Mailing Address - Street 1:5911 N LEADER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5625
Mailing Address - Country:US
Mailing Address - Phone:773-332-7382
Mailing Address - Fax:773-305-0915
Practice Address - Street 1:5911 N LEADER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5625
Practice Address - Country:US
Practice Address - Phone:773-332-7382
Practice Address - Fax:773-305-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10-7278103K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty