Individual
JACOB GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 E ARMSTRONG AVE, PEORIA, IL 61603-3201
(309) 686-1177
Mailing address
398 HOLLAND RD, GERMANTOWN HILLS, IL 61548-8345
(309) 253-2108
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-208037
IL
Other
Enumeration date
04/09/2025
Last updated
09/25/2025
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