Healthcare Provider Details

I. General information

NPI: 1558149088
Provider Name (Legal Business Name): GABRIELLE ALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 W 159TH ST
ORLAND PARK IL
60467-4416
US

IV. Provider business mailing address

11225 W 159TH ST
ORLAND PARK IL
60467-4416
US

V. Phone/Fax

Practice location:
  • Phone: 773-954-2429
  • Fax:
Mailing address:
  • Phone: 773-954-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: