Jacob Dierlam

NPI #1205426533 in Glen Ellyn, Illinois

Provider Information

NPI Number: 1205426533
Entity Type: Individual
Name: Jacob Dierlam
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Jan 20, 2021
Last Updated: Jan 20, 2021

Practice Location

Address: 880 ROOSEVELT RD
City: Glen Ellyn
State: Illinois
ZIP Code: 60137-7840
Phone: (815) 469-1500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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