Individual
JACQUELYN ROSE FARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT-16-19382
Contact information
Practice address
1707 S 5TH PL, ST CHARLES, IL 60174-4324
(630) 335-9962
Mailing address
1707 S 5TH PL, ST CHARLES, IL 60174-4324
(630) 335-9962
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-19382
IL
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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