Jack Henry Jake London, RBT

NPI #1619556982 in Champaign, Illinois

Provider Information

NPI Number: 1619556982
Entity Type: Individual
Name: Jack Henry Jake London, RBT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Credential: RBT
Enumeration Date: Apr 5, 2021
Last Updated: Apr 5, 2021

Practice Location

Address: 4112 FIELDSTONE RD
Address 2: SUITE B
City: Champaign
State: Illinois
ZIP Code: 61822-6182
Phone: (888) 308-3728

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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