Organization
EB PEDIATRIC RESOURCES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BENNEY MA DT CIMI (PRESIDENT)
(773) 615-3202
Entity
Organization
Contact information
Practice address
3712 N BROADWAY ST # 250, CHICAGO, IL 60613-4235
(773) 615-3202
Mailing address
3712 N BROADWAY ST # 250, CHICAGO, IL 60613-4235
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
222Q00000X
Developmental Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/30/2007
Last updated
08/31/2015
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