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Organization
BLUE BOLT PEDIATRIC CARE
Active
Organization
BLUE BOLT PEDIATRIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY GROBEN M.S. ED., BCBA (BOARD CERTIFIED BEHAVIOR ANALYST)
(917) 580-2599
Entity
Organization
Contact information
Practice address
800 ELGIN RD APT 1218, EVANSTON, IL 60201-5628
(917) 580-2599
Mailing address
1555 SHERMAN AVE # 324, EVANSTON, IL 60201-4421
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
07/06/2024
Last updated
04/04/2025
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