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General NPI Number Information
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NPI Number | 1447190418
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Entity Type | Individual
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Provider Name | ALICIA ANA MENDOZA
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Gender | Female
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 800 S MCHENRY AVE STE F
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7487
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Country | US
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Telephone | 815-526-3750
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Fax | 815-526-3440
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Provider Business Mailing Address
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Address Line | 800 S MCHENRY AVE STE F 183 N ADDISON AVE APT. 307 ELMHURST IL 60126
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7487
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Country | US
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Telephone | 815-526-3750
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Fax | 815-526-3440
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.022777
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License Number State | IL
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