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General NPI Number Information
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NPI Number | 1912823964
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Entity Type | Individual
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Provider Name | ALEJANDRA PROVENZALE
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Gender | Female
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 23917 W ROBERT AVE
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City | PLAINFIELD
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State | IL
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Zip | 60544-3161
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Country | US
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Telephone | 815-656-7827
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 LACEY RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1839
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Country | US
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Telephone | 815-503-1869
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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-25-465535
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License Number State | IL
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