Neurodivergent Provider Directory-Chicagoland
Name of Organization/Practice/ Group
Location- City and County
Address (if you would like it shared)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
We offer virtual services:
ONLY- no physical location
For some of our services
We do not currently any virtual offerings
Point of Contact for Coordination of Services/ Questions
First Name
Last Name
E-mail for Coordination/Questions
example@example.com
Phone Number
-
Area Code
Phone Number
General Hours of Operation:
What services do you provide? (May include overview or a breakdown of individual services)
What population(s) do you serve? (Please include age ranges, diagnoses you have experiences and training to work with, specializations etc).
If you are providing a professional service, what are your qualifications (degrees, trainings, licenses, certifications etc.)
What makes your practice/services neuroaffirming?
Is your service/organization run by neurodivergent individuals, or does it employ neurodivergent individuals?
Run by
Employs
Both
Neither
Does your practice/organization take insurance?
Yes for all services
For some services
Self Pay
Non billable services
If yes, which services are eligible and what insurances do you take?
Are you accepting new clients/participants?
Yes for all services
Yes for some services
Waitlist available
No, and no current waitlist
If you have a waitlist, what a general estimate for wait time?
Social Media Handle
Is there anything else you would like our community members to know about you your practice, organization or services?
I would like to be contacted for further discussion, follow up or collaborations?
Yes, please!
Not at this time
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