Individual
THEODORE ISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 N MARSHFIELD AVE, CHICAGO, IL 60622-6731
(312) 243-6097
Mailing address
520 N MARSHFIELD AVE, CHICAGO, IL 60622-6731
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362678083
—
IL
Enumeration date
09/18/2018
Last updated
09/18/2018
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