Provider Demographics
NPI:1962716365
Name:AUTISM INTERVENTIONS, INC.
Entity type:Organization
Organization Name:AUTISM INTERVENTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:630-886-8375
Mailing Address - Street 1:3921 N MOZART ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3619
Mailing Address - Country:US
Mailing Address - Phone:630-886-8375
Mailing Address - Fax:
Practice Address - Street 1:3921 N MOZART ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3619
Practice Address - Country:US
Practice Address - Phone:630-886-8375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTC92450503P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty