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General NPI Number Information
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NPI Number | 1033825567
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Entity Type | Individual
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Provider Name | ALESSANDRA ALTOM
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Gender | Female
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 484 W BOUGHTON RD STE C
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2478
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Country | US
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Telephone | 312-858-8562
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 CHIPPEWA ST
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City | NORMAL
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State | IL
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Zip | 61761-5760
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Country | US
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Telephone | 224-587-0552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-63261
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License Number State | IL
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