Basic Information
| Provider Information | |||||||||
| NPI: | 1003384512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | ISABEL | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 REVERE DR | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600621566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442477222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 805 MAY ST | ||||||||
| Address2: | |||||||||
| City: | WAUKEGAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600857450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2243813795 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2018 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | RBT-18-57121 | IL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.