Most Relevant Information
Provider Data
| NPI Number: | 1003643974 |
| Provider Name: | MARISSA KEO |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/16/2024 |
| Last Updated: | 09/16/2024 |
Provider Practice Location
917 SHERWOOD DR STE 201
LAKE BLUFF
IL
600442235
Practice Location Phone/Fax
| Phone: | 8774864140 |
| Fax: |
Provider Mailing Location
39218 N STOCKTON LN
BEACH PARK
IL
600833011
Provider Mailing Phone/Fax
| Phone: | 2245049512 |
| Fax: |