Individual
JESSICA BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 W DIVERSEY PKWY UNIT G-2, CHICAGO, IL 60614-1201
(802) 922-4860
Mailing address
1209 W DIVERSEY PKWY UNIT G-2, CHICAGO, IL 60614-1201
(802) 922-4860
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.018663
IL
106S00000X
Behavior Technician
—
IL
Other
Enumeration date
03/10/2019
Last updated
12/03/2022
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