1356205538 NPI number — CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356205538 NPI number — CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356205538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4132 N BELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60618-2914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2123 W IRVING PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-636-6975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
VANDER PLOEG BOOTH
Authorized Official First Name:
KARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-636-6975

Provider Taxonomy Codes

  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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