Provider Demographics
NPI:1386478436
Name:INCLUSIVE CLUB FOR NEURODIVERSITY
Entity type:Organization
Organization Name:INCLUSIVE CLUB FOR NEURODIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:847-323-7275
Mailing Address - Street 1:1550 N LAKE SHORE DR APT 16D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 N LAKE SHORE DR APT 16D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6600
Practice Address - Country:US
Practice Address - Phone:847-323-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty