1568747202 NPI number — THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO

Table of content: (NPI 1568747202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568747202 NPI number — THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO
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:
1568747202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 W BOUGHTON RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-1898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-759-1732
Provider Business Mailing Address Fax Number:
630-759-5220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 W BOUGHTON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BOLINGBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60440-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-759-1732
Provider Business Practice Location Address Fax Number:
630-759-5220
Provider Enumeration Date:
10/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
630-759-1732

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  071007322 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PTAN IS IL 3090 . This is a "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN) IS IL3090" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com