Individual
JACLYN GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
4801 W PETERSON AVE, SUITE 512, CHICAGO, IL 60646-5713
(773) 539-7099
(773) 539-8099
Mailing address
4054 N PAULINA ST APT 2S, CHICAGO, IL 60613-2574
(440) 452-8046
(773) 539-8099
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-12623
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08258
—
OH
Enumeration date
11/15/2007
Last updated
01/31/2013
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