Organization
FOREST CITY BEHAVIOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIN WADE PHD (PRESIDENT)
(815) 627-0641
Entity
Organization
Contact information
Practice address
807 MONROE ST, MENDOTA, IL 61342-1662
(815) 627-0641
(270) 514-8294
Mailing address
807 MONROE ST, MENDOTA, IL 61342-1662
(815) 627-0641
(270) 514-8294
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
071-007297
IL
Other
Enumeration date
07/18/2016
Last updated
07/18/2016
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