Healthcare Provider Details

I. General information

NPI: 1487575676
Provider Name (Legal Business Name): MATTHEW ISAAC ALLERTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 N CALIFORNIA AVE APT 1N
CHICAGO IL
60618-5896
US

IV. Provider business mailing address

3234 N CALIFORNIA AVE APT 1N
CHICAGO IL
60618-5896
US

V. Phone/Fax

Practice location:
  • Phone: 312-961-8506
  • Fax:
Mailing address:
  • Phone: 312-961-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: