Individual
NICOLE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4110 LITT DR, HILLSIDE, IL 60162-1120
(708) 570-3560
Mailing address
1815 S WOLF RD, HILLSIDE, IL 60162-2110
(708) 236-0979
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000006
—
IL
Enumeration date
05/09/2016
Last updated
05/09/2016
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