Healthcare Provider Details

I. General information

NPI: 1447658414
Provider Name (Legal Business Name): JESSICA LATSHAW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 MERIDIAN PKWY
AURORA IL
60504-7938
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 301
BURBANK CA
91505-5025
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: