Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | RBT-18-57121 | IL |
NPI | 1003384512 |
---|---|
Provider Name | Isabel A Perez |
First Address | Northbrook, IL 60062-1566 |
Second Address | Waukegan, IL 60085-7450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 02/11/2018 |