Provider Demographics
NPI:1649983032
Name:TIME TO SHINE ABA LLC
Entity type:Organization
Organization Name:TIME TO SHINE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYSOGLAD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:630-779-3029
Mailing Address - Street 1:21 BOULDER HILL PASS
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-1911
Mailing Address - Country:US
Mailing Address - Phone:630-331-3667
Mailing Address - Fax:
Practice Address - Street 1:21 BOULDER HILL PASS
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-1911
Practice Address - Country:US
Practice Address - Phone:630-331-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty