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General NPI Number Information
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NPI Number | 1619410511
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Entity Type | Individual
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Provider Name | JESENIA PEREZ
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 452 N EOLA RD STE A
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City | AURORA
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State | IL
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Zip | 60502-9110
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Country | US
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Telephone | 630-999-0401
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Fax | 630-423-9669
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Provider Business Mailing Address
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Address Line | 2796 CRANSTON CIR
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City | YORKVILLE
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State | IL
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Zip | 60560-4613
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Country | US
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Telephone | 708-691-3924
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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 | BACB337139
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License Number State | IL
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