Healthcare Provider Details

I. General information

NPI: 1306775341
Provider Name (Legal Business Name): ALICIA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BARNEY DR APT 212
JOLIET IL
60435-5296
US

IV. Provider business mailing address

905 LOIS PL APT 212
JOLIET IL
60435-3616
US

V. Phone/Fax

Practice location:
  • Phone: 708-374-5558
  • Fax: 779-206-2581
Mailing address:
  • Phone: 708-374-5558
  • Fax: 779-206-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-525871
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: