Provider Demographics
NPI:1982174934
Name:FIGUEROA, JEANETTE (RBT-18-72034)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:F
Credentials:RBT-18-72034
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5145
Mailing Address - Country:US
Mailing Address - Phone:177-356-9559
Mailing Address - Fax:
Practice Address - Street 1:4937 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-5145
Practice Address - Country:US
Practice Address - Phone:177-356-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-72034106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician