Healthcare Provider Details

I. General information

NPI: 1194562207
Provider Name (Legal Business Name): JAMIE KATHLEEN LATUSZEK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E WILMETTE RD STE E
PALATINE IL
60074-6495
US

IV. Provider business mailing address

1008 E LILAC DR
PALATINE IL
60074-1604
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-0955
  • Fax:
Mailing address:
  • Phone: 847-409-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: