Provider Demographics
NPI:1821656539
Name:SUFFIELD, ALYSE C (BBCA)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:C
Last Name:SUFFIELD
Suffix:
Gender:F
Credentials:BBCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 OLD ORCHARD RD SUITE 15
Mailing Address - Street 2:ALYSE@ORANGE4KIDZ.COM
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-779-3278
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD STE 15
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1027
Practice Address - Country:US
Practice Address - Phone:847-779-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-21-49183103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty