Healthcare Provider Details

I. General information

NPI: 1477299576
Provider Name (Legal Business Name): ANNALYSE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNALYSE MAZE

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SHERWOOD DR STE 201
LAKE BLUFF IL
60044-2235
US

IV. Provider business mailing address

730 DILLON CT
GRAYSLAKE IL
60030-3374
US

V. Phone/Fax

Practice location:
  • Phone: 877-486-4140
  • Fax:
Mailing address:
  • Phone: 847-873-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87875
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: