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NPI Code Detail

MEDICARE: ANGELICA GALLEGOS BCBA 1-21-48488

MEDICARE: ANGELICA GALLEGOS BCBA 1-21-48488
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 TechnicianRBT-19-75290IL
2103K00000XBehavior Analyst1-21-48488IL

General Provider Information

NPI Number : 1730653049
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA GALLEGOS BCBA 1-21-48488
Provider Business Mailing Address
First Line : 372 DORCHESTER LN
Second Line :
City : GRAYSLAKE
State : IL
Zip : 60030-3429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2019
Last Update Date : 04/12/2021

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