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General NPI Number Information
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NPI Number | 1235975822
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Entity Type | Individual
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Provider Name | CASSIDY MARTINEZ RBT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 2801 W HOWARD ST
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City | CHICAGO
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State | IL
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Zip | 60645-1228
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Country | US
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Telephone | 773-305-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 CHALET RD APT 303
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City | NAPERVILLE
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State | IL
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Zip | 60563-8964
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Country | US
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Telephone | 331-250-9926
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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-24-8360-743243
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License Number State | IL
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