Provider Demographics
NPI:1316257850
Name:ROUSE, LINDSAY (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W WASHINGTON BLVD UNIT 238
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2152
Mailing Address - Country:US
Mailing Address - Phone:917-881-4058
Mailing Address - Fax:
Practice Address - Street 1:1000 W WASHINGTON BLVD UNIT 238
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2152
Practice Address - Country:US
Practice Address - Phone:917-881-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1106983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst