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Organization
INDEPENDENT WITH AUTISM
Active
Organization
INDEPENDENT WITH AUTISM
Active
Parent organization
MIND BODY LIFE
Other names
Independent With Autism
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIND BODY LIFE
Authorized official
MS. SUSAN PERKOWITZ (OWNER)
(847) 274-9413
Entity
Organization
Contact information
Practice address
100 SAUNDERS RD STE 150, LAKE FOREST, IL 60045-2526
(847) 275-9413
Mailing address
2549 WAUKEGAN RD STE 55, BANNOCKBURN, IL 60015-1569
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106E00000X
Assistant Behavior Analyst
—
—
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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