Healthcare Provider Details

I. General information

NPI: 1053239145
Provider Name (Legal Business Name): LILLIAN M VANALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 EAGLERIDGE CIR
PUEBLO CO
81008-2176
US

IV. Provider business mailing address

4710 EAGLERIDGE CIR
PUEBLO CO
81008-2176
US

V. Phone/Fax

Practice location:
  • Phone: 720-551-2551
  • Fax: 720-551-2551
Mailing address:
  • Phone: 720-551-2551
  • Fax: 720-551-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: