Provider Demographics
NPI:1134509854
Name:ERGANG, ALLISON LOUISE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LOUISE
Last Name:ERGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 W WINDSOR AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1612
Mailing Address - Country:US
Mailing Address - Phone:224-406-5784
Mailing Address - Fax:
Practice Address - Street 1:2170 W WINDSOR AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1612
Practice Address - Country:US
Practice Address - Phone:224-406-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist