Healthcare Provider Details

I. General information

NPI: 1972430437
Provider Name (Legal Business Name): CHARDONNAY NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COLLINS ST
JOLIET IL
60432-2916
US

IV. Provider business mailing address

231 E INDIAN TRL
AURORA IL
60505-1732
US

V. Phone/Fax

Practice location:
  • Phone: 630-300-3400
  • Fax:
Mailing address:
  • Phone: 630-300-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: