Healthcare Provider Details

I. General information

NPI: 1346026200
Provider Name (Legal Business Name): JASMINE NICOLE CATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 GRAND AVE
WAUKEGAN IL
60085-2406
US

IV. Provider business mailing address

6777 W 88TH ST
OAK LAWN IL
60453-1015
US

V. Phone/Fax

Practice location:
  • Phone: 224-207-8567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-272750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: