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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