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General NPI Number Information
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NPI Number | 1821560681
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Entity Type | Individual
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Provider Name | ALEXANDRIA FOTOPOULOS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 7435 W MANITOBA DR
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2017
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Country | US
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Telephone | 708-912-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 110 COLLINS ST
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City | JOLIET
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State | IL
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Zip | 60432-2942
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Country | US
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Telephone | 815-727-6997
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Fax | 815-727-6996
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1835966
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License Number State | IL
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