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General NPI Number Information
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NPI Number | 1730653049
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Entity Type | Individual
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Provider Name | ANGELICA GALLEGOS BCBA 1-21-48488
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Gender | Female
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Dates
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Enumeration Date | 01/20/2019
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 854 TECHNOLOGY WAY
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5350
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Country | US
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Telephone | 847-816-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 372 DORCHESTER LN
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City | GRAYSLAKE
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State | IL
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Zip | 60030-3429
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-75290
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-48488
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License Number State | IL
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