Healthcare Provider Details

I. General information

NPI: 1609295757
Provider Name (Legal Business Name): JMK BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W EASTMAN ST STE 102B
ARLINGTON HEIGHTS IL
60004-5948
US

IV. Provider business mailing address

120 W EASTMAN ST STE 102B
ARLINGTON HEIGHTS IL
60004-5948
US

V. Phone/Fax

Practice location:
  • Phone: 815-713-8792
  • Fax:
Mailing address:
  • Phone: 815-713-8792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-6811
License Number StateIL

VIII. Authorized Official

Name: MS. JOANNA MARIE KOOISTRA
Title or Position: PRESIDENT
Credential: MS, BCBA
Phone: 815-713-8792