Provider Demographics
NPI:1043060635
Name:FAUDOA, ALONDRA ERADNSA (MS)
Entity Type:Individual
Prefix:
First Name:ALONDRA
Middle Name:ERADNSA
Last Name:FAUDOA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 SQUALL WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8496
Mailing Address - Country:US
Mailing Address - Phone:720-338-0834
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 300
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4616
Practice Address - Country:US
Practice Address - Phone:309-212-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health