Individual
JONATHAN ALEXIS LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2248 S MICHIGAN AVE, CHICAGO, IL 60616-5258
(312) 672-1165
Mailing address
2248 S MICHIGAN AVE, CHICAGO, IL 60616-5258
(312) 286-2444
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IL
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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