Healthcare Provider Details

I. General information

NPI: 1194482158
Provider Name (Legal Business Name): RACHEL FANELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date: 04/15/2026
Reactivation Date: 05/12/2026

III. Provider practice location address

1721 MOON LAKE BLVD STE 130-140
HOFFMAN ESTATES IL
60169-1069
US

IV. Provider business mailing address

0N562 ARMSTRONG LN
GENEVA IL
60134-6118
US

V. Phone/Fax

Practice location:
  • Phone: 312-965-2997
  • Fax: 312-929-0324
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.00051
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: