MEDICARE: ARIANA GALLE

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SKQAN5834765	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790277895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANA GALLE

Provider Business Mailing Address
First Line	:	514 N ELMHURST AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2014
Country	:	US
Telephone Number	:	847-342-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 N ELMHURST AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2014
Country	:	US
Telephone Number	:	847-502-7552
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	06/16/2018

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Directions to “ ARIANA GALLE ” Practice Location

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