Provider Demographics
NPI:1710129440
Name:KOROLEVA-REGALADO, ALEXANDRA (M ED)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:KOROLEVA-REGALADO
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:KOROLEVA-REGALADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1495 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3516
Mailing Address - Country:US
Mailing Address - Phone:847-387-7342
Mailing Address - Fax:
Practice Address - Street 1:1495 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3516
Practice Address - Country:US
Practice Address - Phone:847-387-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-12-10534103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAK90310610POtherDEPARTMENT OF HUMAN SERVICES PART C