Healthcare Provider Details

I. General information

NPI: 1194204057
Provider Name (Legal Business Name): SARA MARTINEZ M.S. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 95TH ST
NAPERVILLE IL
60564-8033
US

IV. Provider business mailing address

607 E LEE ST
PLANO IL
60545-1306
US

V. Phone/Fax

Practice location:
  • Phone: 630-687-9437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43730
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-62680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: