Healthcare Provider Details

I. General information

NPI: 1164912440
Provider Name (Legal Business Name): DANIELLE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2018
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR
NORTHBROOK IL
60062-1563
US

IV. Provider business mailing address

725 72ND ST
DOWNERS GROVE IL
60516-3940
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.012622
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: