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General NPI Number Information
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NPI Number | 1811887466
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Entity Type | Individual
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Provider Name | IMANUEL P ACERA
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 332 S MICHIGAN AVE STE 900
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City | CHICAGO
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State | IL
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Zip | 60604-4393
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Country | US
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Telephone | 813-395-1073
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Fax |
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Provider Business Mailing Address
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Address Line | 5950 N KENMORE AVE APT 502
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City | CHICAGO
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State | IL
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Zip | 60660-3684
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Country | US
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Telephone | 309-642-8537
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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-25-450685
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License Number State | IL
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