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SUPERHERO BEHAVIOR LLC
Complete NPI Record 1497483945
Behavior Analyst in Oswego, IL

NPI Status: Active since August 11, 2022

Contact Information

412 SUDBURY CIR
OSWEGO, IL
ZIP 60543
Phone: (630) 362-5979

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. Authorized Official Credential Text
  27. Healthcare Provider Taxonomy Group 1
  28. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1497483945. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1497483945
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’’.
Entity Type Code: 2
The State code in the location of the provider being identified.
Employer Identification Number EIN: UNAVAIL
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’’.
The country code in the location address of the provider being identified.
Provider First Line Business Mailing Address: 412 SUDBURY CIR
The city name in the location address of the provider being identified.
Provider Business Mailing Address City Name: OSWEGO
The State code in the location of the provider being identified.
Provider Business Mailing Address State Name: IL
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 Mailing Address Postal Code: 605437149
The country code in the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The telephone number associated with the location address of the provider being identified.
Provider Business Mailing Address Telephone Number: 6303625979
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 First Line Business Practice Location Address: 412 SUDBURY CIR
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: OSWEGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 605437149
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
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6303625979
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/11/2022
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/11/2022
Authorized Official Last Name: NORRIS
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: KATHLEEN
The first name of the authorized official.
Authorized Official Title or Position: FOUNDER
The title or position of the authorized official.
Authorized Official Telephone Number: 6303625979
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 103K00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
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).
Is Organization Subpart: N
Authorized Official Credential Text: BCBA
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
NPI Certification Date: 8/11/2022
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.