Healthcare Provider Details

I. General information

NPI: 1164985321
Provider Name (Legal Business Name): MATTI RIVOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

IV. Provider business mailing address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

V. Phone/Fax

Practice location:
  • Phone: 815-608-7224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: