Provider Demographics
NPI:1447008883
Name:CHILDERS, EMMA CLAIRE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:CLAIRE
Last Name:CHILDERS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:EMRY
Other - Middle Name:CLAIRE
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5713 W EDDY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4320
Mailing Address - Country:US
Mailing Address - Phone:918-708-2252
Mailing Address - Fax:
Practice Address - Street 1:7250 N CICERO AVE STE 220
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1627
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician