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General NPI Number Information
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NPI Number | 1851189211
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Entity Type | Individual
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Provider Name | MISS ALLIAH ROSE CLEOFAS
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 4615 W 103RD ST
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City | OAK LAWN
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State | IL
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Zip | 60453-4718
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Country | US
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Telephone | 331-229-8843
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Fax |
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Provider Business Mailing Address
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Address Line | 6040 LAKE BLUFF DR UNIT 102
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City | TINLEY PARK
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State | IL
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Zip | 60477-7149
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Country | US
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Telephone | 708-870-4063
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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 |
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License Number State | IL
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