London, Jack Henry Jake

London, Jack Henry Jake is an individual health care provider with primary practice located at 4112 Fieldstone Rd Suite B, Champaign IL 61822-6182. He recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as his primary health care specialty. London, Jack Henry Jake can be contacted via phone (888) 308-3728.

Contact Information

Primary practice address
4112 Fieldstone Rd Suite B Champaign IL 61822-6182
Phone: (888) 308-3728
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X 20142911

Profile Details

NPI number 1619556982
LBN Legal business name London, Jack Henry Jake
Credentials RBT
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2021
Last updated Apr 5th, 2021 - about 4 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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