Provider Demographics
NPI:1396883625
Name:NORTHWESTERN SUBURBAN SPECIAL EDUCATION ORGANIZATION
Entity type:Organization
Organization Name:NORTHWESTERN SUBURBAN SPECIAL EDUCATION ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNOLOGY COORDINATOR FOR MANAGEM
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DENENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:847-463-8120
Mailing Address - Street 1:799 W KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1111
Mailing Address - Country:US
Mailing Address - Phone:847-463-8120
Mailing Address - Fax:
Practice Address - Street 1:799 W KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1111
Practice Address - Country:US
Practice Address - Phone:847-463-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid