Provider Demographics
NPI:1427501881
Name:DETTMERING, JAMINE L (BCBA)
Entity type:Individual
Prefix:
First Name:JAMINE
Middle Name:L
Last Name:DETTMERING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 W GRACE ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4217
Mailing Address - Country:US
Mailing Address - Phone:563-505-8960
Mailing Address - Fax:
Practice Address - Street 1:3502 W GRACE ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4217
Practice Address - Country:US
Practice Address - Phone:563-505-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst