Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-74847 | IL |
NPI | 1003370198 |
---|---|
Provider Name | Jocelyn Castillo |
First Address | Northbrook, IL 60062-8005 |
Second Address | Northbrook, IL 60062-8005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2019 |
Last Update Date | 23/01/2019 |