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General NPI Number Information
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NPI Number | 1609295757
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Entity Type | Organization
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Legal Business Name | JMK BEHAVIOR SERVICES
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 120 W EASTMAN ST STE 102B
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-5948
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Country | US
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Telephone | 815-713-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W EASTMAN ST STE 102B
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-5948
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Country | US
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Telephone | 815-713-8792
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JOANNA MARIE KOOISTRA
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Credential | MS, BCBA
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Telephone | 815-713-8792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-6811
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License Number State | IL
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