MEDICARE: MR. ABRAHAM JACOB SAENZ B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1154556413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABRAHAM JACOB SAENZ B.A.

Provider Business Mailing Address
First Line	:	4308 W 55TH ST
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60632-4628
Country	:	US
Telephone Number	:	312-451-4814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4308 W 55TH ST
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60632-4628
Country	:	US
Telephone Number	:	312-451-4814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	05/15/2009

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