Healthcare Provider Details

I. General information

NPI: 1265959860
Provider Name (Legal Business Name): AARON BARAJAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W MADISON ST
OTTAWA IL
61350-2833
US

IV. Provider business mailing address

424 W MADISON ST
OTTAWA IL
61350-2833
US

V. Phone/Fax

Practice location:
  • Phone: 815-434-3953
  • Fax: 815-433-3980
Mailing address:
  • Phone: 815-434-3953
  • Fax: 815-433-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: