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NPI Code Detail

MEDICARE: MRS. LAUREL RAE JOSS M.A, ECED

MEDICARE: MRS. LAUREL RAE JOSS M.A, ECED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1588804504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREL RAE JOSS M.A, ECED
Provider Business Mailing Address
First Line : 10235 SOUTHWEST HWY
Second Line :
City : CHICAGO RIDGE
State : IL
Zip : 60415-1350
Country : US
Telephone Number : 708-508-8944
Fax Number :
Provider Business Practice Location Address
First Line : 10235 SOUTHWEST HWY
Second Line :
City : CHICAGO RIDGE
State : IL
Zip : 60415-1350
Country : US
Telephone Number : 708-508-8944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2009
Last Update Date : 03/03/2009

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