MEDICARE: ANGELA NAYELI BOLANOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1063374726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA NAYELI BOLANOS

Provider Business Mailing Address
First Line	:	113 BLUEGRASS PKWY
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 PARK ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4861
Country	:	US
Telephone Number	:	877-486-4140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ ANGELA NAYELI BOLANOS ” Practice Location

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