Provider Demographics
NPI:1881187383
Name:FLORES, JASMINE (RBT-17-33128)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:RBT-17-33128
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-1505
Mailing Address - Country:US
Mailing Address - Phone:224-944-6725
Mailing Address - Fax:
Practice Address - Street 1:2515 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-1505
Practice Address - Country:US
Practice Address - Phone:224-944-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-33128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician