Individual
JACOB COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12122 S INDIANA AVE, CHICAGO, IL 60628-6737
(847) 890-8548
Mailing address
12122 S INDIANA AVE, CHICAGO, IL 60628-6737
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/24/2025
Last updated
02/24/2025
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