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General NPI Number Information
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NPI Number | 1225855687
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Entity Type | Individual
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Provider Name | JAMIE MARASCO GEBHARDT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 6430 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60646-2925
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Country | US
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Telephone | 312-806-7937
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Fax |
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Provider Business Mailing Address
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Address Line | 830 N MILWAUKEE AVE APT 406
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City | CHICAGO
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State | IL
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Zip | 60642-4299
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Country | US
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Telephone | 414-801-1255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-378357
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License Number State | IL
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