Healthcare Provider Details

I. General information

NPI: 1265203459
Provider Name (Legal Business Name): JAQUELYN MENDRO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 38TH AVE
ST CHARLES IL
60174-5411
US

IV. Provider business mailing address

8201 CASS AVE
DARIEN IL
60561-5314
US

V. Phone/Fax

Practice location:
  • Phone: 630-509-8700
  • Fax: 630-326-7175
Mailing address:
  • Phone: 630-590-5571
  • 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: