Individual
JONAH DANIEL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
900 ROYAL HEIGHTS RD, BELLEVILLE, IL 62226-5457
(314) 560-7063
Mailing address
PO BOX 58, 405 WEST WARD, ENERGY, IL 62933-0058
(618) 534-0315
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-09-5883
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-09-5883
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
09/03/2015
Last updated
09/03/2015
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