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General NPI Number Information
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NPI Number | 1912777491
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Entity Type | Individual
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Provider Name | JESSICA SERNA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1711 N AUTUMN DR
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City | JOLIET
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State | IL
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Zip | 60431-8530
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Country | US
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Telephone | 708-374-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 26308 S HARVEST LN
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City | CRETE
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State | IL
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Zip | 60417-4358
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Country | US
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Telephone |
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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-21-172379
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License Number State | IL
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