Provider Demographics
NPI:1356977490
Name:LETO, EMMA JEAN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JEAN
Last Name:LETO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SCHOOLGATE RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3207
Mailing Address - Country:US
Mailing Address - Phone:815-630-9721
Mailing Address - Fax:
Practice Address - Street 1:19056 HENRY DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9302
Practice Address - Country:US
Practice Address - Phone:708-995-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-20-41124103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst