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NPI Code Detail

MEDICARE: ANDREA ELIZABETH BLACIO

MEDICARE: ANDREA ELIZABETH BLACIO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1053147447
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA ELIZABETH BLACIO
Provider Business Mailing Address
First Line : 3234 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-8306
Country : US
Telephone Number : 773-691-6442
Fax Number :
Provider Business Practice Location Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number : 877-486-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2024
Last Update Date : 09/11/2024

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Directions to “ ANDREA ELIZABETH BLACIO ” Practice Location

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