Individual
JACLYN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6825 N OLCOTT AVE, CHICAGO, IL 60631-1127
(224) 305-1203
Mailing address
3839 CLIFFORD TER, SKOKIE, IL 60076-2804
(847) 347-5949
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
738971
IL
Other
Enumeration date
09/22/2025
Last updated
09/22/2025
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