Organization
EASTER SEALS - UCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA RIDDLE CPA, CGMA (PRESIDENT)
(309) 686-1177
Entity
Organization
Contact information
Practice address
507 E ARMSTRONG AVE, PEORIA, IL 61603-3201
(309) 686-1777
(309) 686-7722
Mailing address
507 E ARMSTRONG AVE, PEORIA, IL 61603-3201
(309) 686-1177
(309) 686-7722
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251K00000X
Public Health or Welfare Agency
—
—
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
=========
—
IL
Enumeration date
11/14/2005
Last updated
02/26/2024
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