MEDICARE: GLORIA VELINO

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1326683616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA VELINO

Provider Business Mailing Address
First Line	:	5 REVERE DR STE 120
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-8005
Country	:	US
Telephone Number	:	847-564-0822
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 BUTTE VIEW DR
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60490-1518
Country	:	US
Telephone Number	:	630-567-3053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	11/11/2019

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Directions to “ GLORIA VELINO ” Practice Location

Language	Start Address	Practice Location

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