Organization
IMPACTING AUTISM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA POULOS M.A.,BCBA (BOARD CERTIFIED BEHAVIOR ANALYST)
(847) 331-5370
Entity
Organization
Contact information
Practice address
1613 W COLONIAL PKWY, SUITE 200, INVERNESS, IL 60067-4827
(847) 331-5370
(847) 202-1150
Mailing address
1613 W COLONIAL PKWY, SUITE 200, INVERNESS, IL 60067-4827
(847) 331-5370
(847) 202-1150
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-09-6494
IL
Other
Enumeration date
03/20/2013
Last updated
07/02/2016
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