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NPI Code Detail

MEDICARE: ADELYNN GISELLE CAMPOVERDE

MEDICARE: ADELYNN GISELLE CAMPOVERDE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1720917172
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADELYNN GISELLE CAMPOVERDE
Provider Business Mailing Address
First Line : 4451 W CORTEZ ST
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3419
Country : US
Telephone Number : 773-543-4636
Fax Number :
Provider Business Practice Location Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number : 877-486-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2026
Last Update Date : 05/13/2026

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Directions to “ ADELYNN GISELLE CAMPOVERDE ” Practice Location

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