AUTISM EVALUATION CENTER AT THE PLACE
Complete NPI Record 1104772987
Psychologist - Clinical in Chicago, IL
Active since March 05, 2026
Complete NPI Dataset
This page contains the complete raw NPPES record for Autism Evaluation Center At The Place (NPI 1104772987), a psychologist organization in Chicago, IL. All 31 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1104772987 Field 1/31
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/31
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/31
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: AUTISM EVALUATION CENTER AT THE PLACE Field 4/31
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 8609 W BRYN MAWR AVE STE 204 Field 5/31
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: CHICAGO Field 6/31
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 7/31
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 606313524 Field 8/31
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/31
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 7733473145 Field 10/31
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 2242413132 Field 11/31
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 8609 W BRYN MAWR AVE STE 204 Field 12/31
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: CHICAGO Field 13/31
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IL Field 14/31
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 606313524 Field 15/31
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/31
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7733473145 Field 17/31
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2242413132 Field 18/31
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: MARQUEZ Field 21/31
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: LLUVIA Field 22/31
- The first name of the authorized official.
- Authorized Official Title or Position: DIRECTOR OF BILLING DEPT Field 23/31
- The title or position of the authorized official.
- Authorized Official Telephone Number: 7736447787 Field 24/31
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 103TC0700X Field 25/31
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 26/31
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 27/31
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: AUTISM EVALUATION CENTER AT THE PLACE Field 28/31
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 29/31
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 30/31
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 18
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2749 Grand Ave
Location 1/18Waukegan, IL 60085-2406 · Phone (773) 347-3145 · Fax (224) 241-3132
2100 S. Morgan St., Suite C101
Location 2/18Chicago, IL 60608 · Phone (773) 347-3145 · Fax (224) 241-3132
301 S Prospect Rd Ste 2
Location 3/18Bloomington, IL 61704-4908 · Phone (773) 347-3145 · Fax (224) 241-3132
140 S River St Ste 102104
Location 4/18Aurora, IL 60506-6077 · Phone (773) 347-3145 · Fax (224) 241-3132
707 E 47th St
Location 5/18Chicago, IL 60653-4201 · Phone (773) 347-3145 · Fax (224) 241-3132
814 N Franklin St
Location 6/18Chicago, IL 60610-3813 · Phone (773) 347-3145 · Fax (224) 241-3132
3033 W Jefferson St
Location 7/18Joliet, IL 60435-5261 · Phone (773) 347-3145 · Fax (224) 241-3132
9400 S Cicero Ave
Location 8/18Oak Lawn, IL 60453-2536 · Phone (773) 347-3145 · Fax (224) 241-3132
14701 S La Grange Rd Fl 2
Location 9/18Orland Park, IL 60462-3226 · Phone (773) 347-3145 · Fax (224) 241-3132
1823 S Neil St
Location 10/18Champaign, IL 61820-7272 · Phone (773) 347-3145 · Fax (224) 241-3132
4145 W Armitage Ave
Location 11/18Chicago, IL 60639-3644 · Phone (773) 347-3145 · Fax (224) 241-3132
5310 W Cermak Rd
Location 12/18Cicero, IL 60804-2816 · Phone (773) 347-3145 · Fax (224) 241-3132
15 Crystal Lake Rd
Location 13/18Lake In The Hills, IL 60156-1206 · Phone (773) 347-3145 · Fax (224) 241-3132
3139 W 111th St
Location 14/18Chicago, IL 60655-2205 · Phone (773) 347-3145 · Fax (224) 241-3132
2701 W Peterson Ave
Location 15/18Chicago, IL 60659-3919 · Phone (773) 347-3145 · Fax (224) 241-3132
6202 W Montrose Ave
Location 16/18Chicago, IL 60634-1556 · Phone (773) 347-3145 · Fax (224) 241-3132
2450 Westfield Dr
Location 17/18Elgin, IL 60124-7836 · Phone (773) 347-3145 · Fax (224) 241-3132
5960 N Milwaukee Ave
Location 18/18Chicago, IL 60646-5424 · Phone (773) 347-3145 · Fax (224) 241-3132
No registry entries match your active lookup criteria.
