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General NPI Number Information
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NPI Number | 1770103269
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Entity Type | Individual
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Provider Name | ALEKSANDRA KOSTIC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 650 W GRAND AVE STE 207
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City | ELMHURST
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State | IL
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Zip | 60126-1025
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Country | US
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Telephone | 844-263-1613
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Fax |
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Provider Business Mailing Address
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Address Line | 41 NICHOLAS DR E
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City | DES PLAINES
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State | IL
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Zip | 60016-6217
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Country | US
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Telephone | 913-575-1750
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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-20-111793
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License Number State | IL
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