Organization
LIFESPEED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY RUSSO (MA, BCBA)
(312) 404-7225
Entity
Organization
Contact information
Practice address
820 DAVIS ST, SUITE 455, EVANSTON, IL 60201-4431
(312) 404-7225
Mailing address
820 DAVIS ST, SUITE 455, EVANSTON, IL 60201-4431
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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