Healthcare Provider Details

I. General information

NPI: 1083912026
Provider Name (Legal Business Name): ALEGRIA HABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 S LAWNDALE AVE
CHICAGO IL
60623-4547
US

IV. Provider business mailing address

2801 S LAWNDALE AVE
CHICAGO IL
60623-4547
US

V. Phone/Fax

Practice location:
  • Phone: 773-456-7551
  • Fax: 773-456-7551
Mailing address:
  • Phone: 773-456-7551
  • Fax: 773-456-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-006604
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146006742
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146007230
License Number StateIL

VIII. Authorized Official

Name: MS. LAURA CABADAS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT
Phone: 773-456-7551