MEDICARE: ESMERALDA GUTIERREZ MA ABA

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1982477931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESMERALDA GUTIERREZ MA ABA

Provider Business Mailing Address
First Line	:	134 HICKORY DR
Second Line	:
City	:	CARPENTERSVILLE
State	:	IL
Zip	:	60110-1654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 FARGO BLVD
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-7504
Country	:	US
Telephone Number	:	920-857-9041
Fax Number	:	920-857-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/01/2023

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