Provider Demographics
NPI:1134662075
Name:GIZOWSKI, JENNIFER FLORENCE (RBT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FLORENCE
Last Name:GIZOWSKI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 N EOLA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9612
Mailing Address - Country:US
Mailing Address - Phone:708-420-7086
Mailing Address - Fax:
Practice Address - Street 1:452 N EOLA RD
Practice Address - Street 2:SUITE B
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9612
Practice Address - Country:US
Practice Address - Phone:708-420-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-15-01068106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician