Provider Demographics
NPI:1497424881
Name:THIELMAN, JACQUELINE ALEXANDRA (RBT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALEXANDRA
Last Name:THIELMAN
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 1:1121 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3321
Mailing Address - Country:US
Mailing Address - Phone:847-852-1022
Mailing Address - Fax:
Practice Address - Street 1:339 LANDAU LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6622
Practice Address - Country:US
Practice Address - Phone:847-243-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-19-81978106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician