Healthcare Provider Details

I. General information

NPI: 1407776933
Provider Name (Legal Business Name): RUBY BARRAZA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19150 88TH AVE
MOKENA IL
60448-8135
US

IV. Provider business mailing address

14557 KARLOV AVE
MIDLOTHIAN IL
60445-2711
US

V. Phone/Fax

Practice location:
  • Phone: 331-282-2005
  • Fax:
Mailing address:
  • Phone: 708-856-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: