Healthcare Provider Details

I. General information

NPI: 1215516901
Provider Name (Legal Business Name): LIZBETH STEPHANIE BERNAL RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 MADISON ST
FOREST PARK IL
60130-1764
US

IV. Provider business mailing address

307 VICTORIA DR
NORTHLAKE IL
60164-2622
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-7225
  • Fax:
Mailing address:
  • Phone: 773-729-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152001039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: