Healthcare Provider Details

I. General information

NPI: 1497213763
Provider Name (Legal Business Name): ALISA CIPRIANO MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 09/21/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E LOOP RD
WHEATON IL
60189-8407
US

IV. Provider business mailing address

140 E LOOP RD
WHEATON IL
60189-8407
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-8487
  • Fax:
Mailing address:
  • Phone: 312-243-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-80339
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: