Provider Demographics
NPI:1457844136
Name:GRASS, JILL MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GRASS
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 1:39441 N CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-8782
Mailing Address - Country:US
Mailing Address - Phone:847-271-0001
Mailing Address - Fax:
Practice Address - Street 1:39441 N CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-8782
Practice Address - Country:US
Practice Address - Phone:847-271-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-40971106S00000X
IL1-20-45810103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician