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General NPI Number Information
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NPI Number | 1902402449
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Entity Type | Individual
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Provider Name | MS. SKYLER RAVEN KERN MARTIN
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Gender | Female
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 3033 W JEFFERSON ST STE 105
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City | JOLIET
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State | IL
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Zip | 60435-5249
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Country | US
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Telephone | 224-291-8831
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Fax |
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Provider Business Mailing Address
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Address Line | DJJE HOLDINGS LLC-THE PLACE FOR CHILDREN WITH AUTISM 8609 W BRYN MAWR AVE STE 204
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City | CHICAGO
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State | IL
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Zip | 60631-3524
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Country | US
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Telephone | 773-644-7787
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-61074
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License Number State | IL
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