Individual
KARISSA BUSTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
710 N AUSTIN BLVD APT 3, OAK PARK, IL 60302-5308
(815) 483-3182
Mailing address
710 N AUSTIN BLVD APT 3, OAK PARK, IL 60302-5308
(847) 306-9843
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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