Individual
JENNIFER MARIE MIKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT-17-38602
Contact information
Practice address
2340 19TH AVE, ROCKFORD, IL 61104-5614
(608) 713-2296
(608) 713-2296
Mailing address
2340 19TH AVE, ROCKFORD, IL 61104-5614
(608) 713-2296
(608) 713-2296
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-38602
IL
Other
Enumeration date
05/13/2018
Last updated
05/13/2018
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