Provider Demographics
NPI:1710739743
Name:ALEXANDER, TAYLOR AMANDA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:AMANDA
Last Name:ALEXANDER
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 1:1721 MOON LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1069
Mailing Address - Country:US
Mailing Address - Phone:708-927-4127
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:708-927-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician