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General NPI Number Information
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NPI Number | 1265310882
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Entity Type | Individual
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Provider Name | JEREMY SERIO
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Gender | Male
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 1921 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-2407
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Country | US
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Telephone | 312-243-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 3812 N PINE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60613-3322
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Country | US
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Telephone | 630-485-8086
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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 |
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License Number State | IL
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