Healthcare Provider Details

I. General information

NPI: 1962367573
Provider Name (Legal Business Name): ALEXICA RONQUILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 LIBERTY BLVD APT 1
WESTMONT IL
60559-1348
US

IV. Provider business mailing address

4101 LIBERTY BLVD APT 1
WESTMONT IL
60559-1348
US

V. Phone/Fax

Practice location:
  • Phone: 630-426-9386
  • Fax:
Mailing address:
  • Phone: 630-426-9386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberR524-00094878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: