Gutierrez, Jaclyn

Gutierrez, Jaclyn is an individual health care provider with primary practice located at 4801 W Peterson Ave Suite 512, Chicago IL 60646-5713. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Gutierrez, Jaclyn can be contacted via phone (773) 539-7099.

Contact Information

Primary practice address
4801 W Peterson Ave Suite 512 Chicago IL 60646-5713
Phone: (773) 539-7099
Fax: (773) 539-8099
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-12-12623

Profile Details

NPI number 1215118567
LBN Legal business name Gutierrez, Jaclyn
Credentials BCBA
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2007
Last updated Jan 31st, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215118567 NPPES
Ohio MEDICAID 08258

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