Individual
AUDREY JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3932 N SOUTHPORT AVE APT 2F, CHICAGO, IL 60613-2606
(847) 306-9843
Mailing address
3932 N SOUTHPORT AVE APT 2F, CHICAGO, IL 60613-2606
(847) 830-0116
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/06/2019
Last updated
02/06/2019
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