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NPI Code Detail

MEDICARE: LISA D IANDOLA

MEDICARE: LISA D IANDOLA
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 TechnicianIL

General Provider Information

NPI Number : 1619829314
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA D IANDOLA
Provider Business Mailing Address
First Line : 390 E CONGRESS PKWY STE 4
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-6202
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 390 E CONGRESS PKWY STE 4
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-6202
Country : US
Telephone Number : 779-284-0347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

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Directions to “ LISA D IANDOLA ” Practice Location

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