Provider Demographics
NPI:1972250900
Name:DEPOY, DALTON
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:DEPOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ROBIN CIR APT 121
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1117
Mailing Address - Country:US
Mailing Address - Phone:217-737-1003
Mailing Address - Fax:
Practice Address - Street 1:901 BIESTERFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3393
Practice Address - Country:US
Practice Address - Phone:217-737-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician