Jeremy Ilog
Behavior Technician in Garden Grove, CA. Individual provider (NPI-1).
NPI number1649129792
StatusActive
Last updated in NPPESJan 22, 2026
Details
- NPI
- 1649129792
- Entity type
- Individual (NPI-1)
- Name
- Jeremy Ilog
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 22, 2026
- Certification date
- Jan 22, 2026
- Last updated
- Jan 22, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
12459 Lewis St Ste 201Garden Grove, CA 92840-6606
Phone 800-249-1266
Mailing address
12459 Lewis St Ste 201Garden Grove, CA 92840-6606
Phone 800-249-1266
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