Provider Demographics
NPI:1801578406
Name:RAZI, ATIYA (BCBA)
Entity type:Individual
Prefix:
First Name:ATIYA
Middle Name:
Last Name:RAZI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DJJE HOLDINGS LLC-THE PLACE FOR CHILDREN WITH AUTISM
Mailing Address - Street 2:8609 W BRYN MAWR AVE STE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3524
Mailing Address - Country:US
Mailing Address - Phone:773-644-7787
Mailing Address - Fax:
Practice Address - Street 1:14701 S LA GRANGE RD FL 2
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3226
Practice Address - Country:US
Practice Address - Phone:224-205-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-23-66220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst